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NgalSo Healing Research Questionnaire on healing experiences with T. Y.S Lama Gangchen Tulku Rinpoche and his NgalSo Self-Healing techniques
This questionnaire is developed to research the effects of Lama Gangchen Tulku Rinpoche’s consultations and the effects of the practice of NgalSo Self-Healing on physical and mental health problems. Please read each question carefully. If you have any medical files that support your experience, please send them to ngalso@kunpen.it. Your information will be kept strictly confidential. Results will only be published anonymously.
Thank you very much for your important contribution and trust!
Untitled Title
Biographical data
If you feel uncomfortable providing name and surname, then you can leave these questions unanswered. However, if you send medical files please put your initials both on the questionnaire and on the medical documents you will send.
Name
Your answer
Surname
Your answer
Email
Your answer
Profession *
Your answer
Country of Residence *
Your answer
Marital status (single, cohabitating, married, divorced, widow/er) *
Your answer
Age *
Your answer
Sex *
General Data on the healing experience
1. What type of healing did you receive? *
2. How did you receive this healing? *
3. Where did you receive this healing? *
4. When did you receive this healing? Specify date(dd/mm/yyyy)/occasion/trip *
Your answer
5. Please make a summary of the experience (what happened, how long did it take, what did you experience) *
Your answer
6. How long after the healing experience did your health improvement start? *
Health problem: the following questions are related to your health problem
7. When did the (symptoms of the) disease, for which you received this healing, first manifest? Indicate the date(dd/mm/yyyy) *
Your answer
8. What kind of symptoms or condition(s) did you experience (nausea, headache, tired, pain, illness)? *
Your answer
9. What was the medical diagnosis made by the physician/psychologist who identified it (example: depression, cancer, heart disease, chronic disease, etc....)? *
Your answer
10. Do you have any medical file about that disease/condition? *
Required
11. What kind of treatments did you receive before or during the healing period? (you can check more than one answer) *
Required
12. If you used Western medicine: which one, what dosage, how many a day? For how long? Please specify- i.e. pill: Tamoxifen 20mg ... 1 times a day for 12 months *
Your answer
13. If you used natural medication: which one, dosage, how many a day? For how long? Please specify Example pill: St.John Wort 300 mg...3 times a day for 6 months
Your answer
14 Did you also consult a Tibetan doctor? *
Required
15. If YES: did she/he confirm the western diagnosis? What kind of therapy did she/he prescribe for you? Please specify (which medicines, lifestyle changes, diet) *
Your answer
Specific data: the following questions are related to the specific healing experience (NgalSo Self- Healing meditation, Chawang NgalSo Reiki, Pilgrimage…)
16. If through the NgalSo Self-Healing meditation, how long have you been practising it? Specify the number of months/years *
Required
17. If through the NgalSo Self-Healing meditation, how long after first starting with Self-Healing did the healing occur? Specify the time span *
Required
18. If through the NgalSo Self-Healing meditation, how often did you practise it before the healing took place? *
19. At that time, how many minutes in total did you practise NgalSo Self-Healing in one week? Specify minutes and hours *
Your answer
20. Did you consult T. S. Y Lama Gangchen Rinpoche about your health problem? *
21. If yes, what did he suggest? Please describe *
Your answer
22. Did you receive and/or practise Chagwang NgalSo Reiki for your health problem? *
23. If yes, please describe your experience *
Your answer
24. Did you go on any pilgrimage with T. Y. S Lama Gangchen Rinpoche for your health problem? *
25. If yes, how many times and where? please describe your experience *
Your answer
The following questions are related to THE EFFECTS of the different treatments you had and the healing experience
26. Did any treatment with natural medicines have any effect on your health problem? *
Required
27 Did the treatment with Western medicines have any effect on your health problem? *
Required
28. Was there any effect with the NgalSo Self-Healing practice on your health problem? *
29. Was there any effect with Chagwang NgalSo Reiki on your health problem? *
30. Did your consultation with the Tibetan doctor have any effect on your health problem? *
31. Did your consultation with T. S. Y Lama Gangchen Tulku Rinpoche have any effect on your health problem? *
Required
32. Did the pilgrimage have any effect on your health problem? *
33. How much of your improvement do you credit to consultation with T. Y. S. Lama Gangchen Tulku Rinpoche ? *
34. How much of your improvement do you credit to consultation with the Tibetan doctor and treatment? *
35. How much of your improvement do you credit to the practice of NgalSo Self-Healing? *
36. How much of your improvement do you credit to practice or receiving Chawang NgalSo Reiki practice? *
37. How much of your improvement do you credit to consultation with western medicine? *
38. How much of your improvement do you credit to consultation with natural medicine *
39. How much of your improvement do you credit to being in a sacred place/ pilgrimage ( Borobudur, Albagnano, Tibet, other) *
40. Did the improvement involve your symptoms/disease *
41. Did the improvement involve your general health status? *
42. Did the improvement involve your ability to mentally cope with your disease? *
43. Did the improvement involve your ability to find meaning in the experience of disease and/or healing? *
not at all
yes
44. Did the improvement involve your ability to progress on your spiritual path? *
not at all
yes
45. Are there any medical records, diagnostic tests, scans before and after the healing you experienced? If yes, please send a scan of your medical records to ngalso@kunpen.it *
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Name
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Surname
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Address
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Post Code
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Town
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Province
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Country
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Place and date of Birth
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Nationality
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Tel/Mobile
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E-mail
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Profession
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hereby declare to have taken note of the content of the Information according to the current privacy legislation prescribed in Italy, Europe and in my country of origin and therefore, give my consent for the use of my personal data, and communication with all bodies (Associations, Foundations, Onlus) founded by Lama Gangchen Tulku Rinpoche in Italy and in the rest of the world: for dharma initiatives, for data processing activities, for the purposes of study and scientific research.
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