Microshield - mobile phone radiation protection cases

Microshield - User Symptoms Registration Microshield - User Symptoms Registration

Microshield - User Symptoms Registration

Have you noticed any ill effects from using your cellular phone?

Since 1995 Microshield has been collating information on symptoms which many users believe have been triggered by their mobile handset (see symptoms pages) Typically these occur either during or after a call and would not have been evident prior to using a mobile. The information gathered by Microshield has formed the basis for a number of papers presented at International conferences around the world and also in submissions of evidence to various Government committees and groups researching the mobile phone health issue.

In their May 2000 report, the UK Government's Independent Expert Group on Mobile Phones agreed for the first time that this anecdotal evidence as it is known, should in future be included for risk assessment purposes by Government protection agencies. In this regard, Microshield has given its commitment to continue collating user's experiences for onward transmission to the relevant authorities.

If you have suffered any health problems as a consequence of your mobile use and want them included in our collation, then please complete the following. Please note that your personal information will be kept confidential to Microshield and will not be divulged to any third party, unless you indicate otherwise in the boxes provided.

Microshield - User Symptoms Registration Microshield - User Symptoms Registration
Please Complete The Following
 Please Provide As Much Information As Possible :

  1. I use my cellular phone:

    Please Select
    Mainly for personal calls
    Mainly for business calls
    Equally for work and private calls

  2. I am aged:

    Please Select
    1-10 years old
    11-18 years old
    19-30 years old
    31-45 years old
    45-60 years old
    60+ years old

  3. Cellular Phone Used -- (Make & Model):

  4. The cellular phone I use belongs to:

    Please Select
    Me and my household
    My employer

  5. I use my cellular phone:

    Please Select
    Less than one hour per week
    One to five hours per week
    Five to ten hours per week
    Ten to fifteen hours per week
    Fifteen to Twenty hours per week
    Twenty hours per week +

  6. Have you had any health problems which you think may be related to your use of a cellular phone? Please check the appropriate box(es)

    Please Select
    Eye & Ear Problems
    Tingling/Burning Sensations
    Dizzy Spells

      Please Include Any Other Relevant Details Below   (ie) If severity increases/decreases with length of call
      Do symptoms disappear when cellular phone is not used for a while?

 Please Provide Your Contact Details :
    Full Name:  
    Phone No:  
    Contact E-Mail:  
Do you want your details to be made available to any Press/TV for possible inclusion in editorial articles on this issue?

You would always be contacted by the publication/program researcher first, before any details were published and no personal details such as name etc, would be used without your express consent.

Please Select
Yes I have no objection to my details being used
No I want my details kept confidential

*Information provided here may be used for our cellular phone health survey

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