Dr. Carlo und seine Fragen an Basisstationsopfer (Allgemein)

H. Lamarr , München, Montag, 24.12.2007, 13:39 (vor 6177 Tagen) @ H. Lamarr

... nachfolgend der Fragebogen für Anwohner von Basisstationen.

Base Stations/Towers Health Concerns Survey

ALL OF THE FOLLOWING INFORMATION THAT YOU PROVIDE TO US THAT IS PERSONAL IN NATURE WILL BE KEPT STRICTLY CONFIDENTIAL

To print a copy, please use either the print button on your browser, or the keyboard print command (usually CTRL+P or Apple+P).

1. Have you ever experienced any symptoms that you feel are related toliving or working in the proximity of mobile phone base stations or towers? Yes/No
a. If yes, what is/was your most troubling symptom?
b. Have your daily activities been affected? Yes/No
c. c. If yes, briefly describe how your activities have been affected.

2. Why do you feel these symptoms are associated with your living or working in the proximity of mobile phone base stations or towers?

3. Have you sought medical attention for these symptoms? Yes/No
a. If yes, have you received a diagnosis? Yes/No
b. If yes, please specify

4. If yes, have you been hospitalized because of this? Yes/No

5. Are you currently experiencing these symptoms? Yes/No

6. How long have you lived or worked in proximity to the base station/tower?
a. Less than 1 year.
b. 1 to 3 years.
c. 4 to 6 years.
d. More than 6 years.

7. On average how many hours/day are you in proximity to the base station/tower?
a. Less than 4 hours a day
b. 4-8 hours/day
c. 9-12 hours/day
d. More than 12 hours a day

8. Gender M/F

9. Age

10. Zip Code

11. State of residence

12. Country of Residence

13. May we contact you if further information is necessary? Yes/No

Name:
Address:

Daytime Phone number:
Evening Phone number:
Email address:

14. How would you prefer we contact you?

15. How did you learn about us?
a. Newspaper
b. Radio/TV
c. Internet
d. Friend/Relative
e. Health Care Provider
f. Other

16. Do you have any other concerns regarding your living or working in the proximity of mobile phone base stations or towers?

Thank you for taking the time to share this valuable information with us.
If you have any questions or comments about this surveillance questionnaire
you can reach us at 866-372-4362.

Science and Public Policy Institute
Health Effects Survey Project
2405 26th Road South
Arlington, VA 22206
Fax: 703-521-5214

--
Jedes komplexe Problem hat eine Lösung, die einfach, naheliegend, plausibel – und falsch ist.
– Frei nach Henry Louis Mencken (1880–1956) –