Barbara H.
>1. NAME: (optional) GENDER:
>
>2. DATE OF Dx: LOCATION: (City,State)
>
>3. AGE AT dx: LOCATION: (City, State)
>
>4. CURRENT AGE: LOCATION: (City, State)
>
>5. BIRTH LOCATION: (City, State)
>
>6. UNUSUAL CIRCUMSTANCES: (Lived in one place, Dx'd in
> another location. There were a few subscribers who were on
> vacation or business).
>
>7. CURRENT MEDICATIONS: (Please List)
>
>8. MEDICATIONS TRIED BUT DID NOT WORK FOR YOU (Please list)
>
>9. IF YOU FEEL THAT YOUR PHYSICIAN/NEUROLOGIST IS
> EXPERIENCED WITH TM (or atleast willing to learn) PLEASE
> LIST HIM AS SOMEONE YOU WOULD RECOMMEND TO OTHERS:
>
> NAME:
> SPECIALTY:
> HOSPITAL AFFILIATION:
> CITY, STATE:
> TELEPHONE:
>
>10. IF YOU HAVE BEEN TREATED BY A PHYSICIAN/NEUROLOGIST
> THAT SHOULD BE AVOIDED AT ALL COSTS BY THOSE WITH TM.
>
> NAME:
> SPECIALTY:
> HOSPITAL AFFILIATION:
> CITY, STATE:
> TELEPHONE:
>
>I hope this information will aide many.
>
>
>Doc
Here is an idea for the letter that I (Phil) would like to have as many
as possible.
(To Whom it may concern)
I am requesting any TM research that you can provide. The research is very
important to me because-------
your signature
mail to Phil Burcham
1677 Grapevine Road
Sissonville W.Va. 25320
I will make multiple copies of your letters and they will become part of a
packet,consisting of a cover letter,TMA newsletter,the April survey report,and
other appropriate documentation. The packets will be shipped to drug
companies,university medical centers and other organizations involved in
either private or public grant funding.I would appreciate your letters ,but
most of all,I want you to share in a successful funding endeavor.
Warm regards, Phil (Photo505)