Fw: Vaccination Questionnaire (email)]

[Guest guest]

This was posted on one of dh's lists. I'm surprised not to have seen it on

the AVN list, but am forwarding for anyone who wishes to help. The person

seeking information is a Naturopath in and describes himself as the

keynote speaker of DVAC (The Drug and Vaccination Awareness Coalition). He

s seeking 10,000 respondents and will be

writing a book.

-------Original Message-------

Vaccination Questionnaire

- Presented by Alan Ostrowsky and the Drug and Vaccination Awareness

Coalition (DVAC)

Please note: Please fill out one questionnaire per person. Each

questionnaire may be completed by the person mentioned in the response or on

behalf of an individual. Such as a parent on behalf of a child.

I sincerely thank you for your efforts in participating in this study. Your

input will contribute to a clearer understanding of the effects of

Vaccinations.

PLEASE FORWARD YOUR COMPLETED QUESTIONNAIRE T0: Alan Ostrowsky 10 Grace

Street ia 3087 , Australia

QUESTION (1) Personal Details: Sex: Male Female

Age: Birth date:

Weight:(kg) Height:(cm)

QUESTION (2) Have you been Vaccinated? Yes No

QUESTION (3) If " Yes " , then up to what age and what vaccines did you receive

?

QUESTION (4) Have you suffered or are suffering from any of the following

conditions?

Asthma Chronic Fatigue

Acne Chronic Low Immunity

Eczema Regular Colds & Flu

Psoriasis Sinus troubles

Vitilago Tonsillitis

Hives Migraines

Hayfever

Ear Infections and/or Glue ear

QUESTION (5) Have you suffered or are suffering from any of the following

conditions?

Bloating Poor digestion

Candida/ Irritable bowel Yeast Infections

Constipation Gall stones

Flatulence Food cravings

QUESTION (6) Have you suffered or are suffering from any of the following

conditions?

AIDS/HIV Cancer

Anaemia Benign Tumours

Arthritis (Osteo) Skin Cancer

Arthritis (Rheum) High Cholesterol

Diabetes High Blood Pressure

Multiple Sclerosis Hepatitis

QUESTION (7) Have you suffered or are suffering from any of the following

conditions?

Autism Obsessive Compulsive

ADD/ADHD Paranoia

Bipolar Schizophrenia

Depression Seizures/Convulsion s

QUESTION (8) Are you suffering from any other health condition/s? NO

If " Yes " please state.

QUESTION (9) Are you taking any regular Pharmaceuticals? NO

If " Yes' please state type/s

QUESTION (10) Have you lost a Child to SIDS NO YES Age:

If so, was he/she vaccinated? NO YES

QUESTION (11) How do you think that you rated academically amongst your age

group?

Excellent Very High Good

Average Below Ave Poor

QUESTION (12) How do you rate your Short term memory?

Excellent Very High Good

Average Below Ave Poor

QUESTION (13) How do you rate your Long term memory?

Excellent Very High Good

Average Below Ave Poor

QUESTION (14) Have you broken any objects in an aggressive manner?

Never Once 2 - 3 times

4 - 6 times 6 - 10 times 10 times +

QUESTION (15) How would you classify yourself in regards to verbally abusing

others? Please include other family members, friends, teachers and sporting

coaches in the thought process.

Never Rare Occasion Once per week

2 -3 times a week 3 - 6 times a week 6 times + a week

QUESTION (16) How would you classify yourself in regards to physically

abusing others? Please include other family members, friends, teachers and

sporting coaches in the decision.

Never Rare Occasion Once per week

2 -3 times a week 3 - 6 times a week 6 times + a week

THANK YOU FOR COMPLETING THE VACCINATION QUESTIONNAIRE. YOUR HELP IS

SINCERELY APPRECIATED.

Cheers ALAN OSTROWSKY

Please Email your response to alanostrowsky@ dodo.com. au or By post to:

Alan Ostrowsky 10 Grace Street ia 3087 Australia

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