Questionnaires

Questionnaires

MELISA questionnaires are used to establish which patients will benefit from MELISA testing, and also which metals should be tested. For example, if a patient cannot tolerate nickel-containing items such as wrist watches, jeans buttons, cheap earrings etc, then the patient probably suffers from nickel allergy. Patients with nickel allergy are more likely to suffer from allergy to other metals as well.

 

A patient who is exposed to metals through dental fillings (amalgam fillings, gold crowns, root-fillings or titanium implants) and/or smokes, has occupational exposure to metals and suffers from unspecific symptoms such as tiredness, joint pain, brain fog etc might also benefit from taking the test.

 

Finally there are certain diseases where metal allergy can trigger or worsen the symptoms. A patient with autoimmunity in the family might want to use the test as a preventive screening.
The questionnaire is available in English, German, French, Spanish, Italian, Swedish and Czech.
Patient questionnaire (fillable pdf)

Patient questionnaire (printable pdf)

Questionnaires in other languages (printable pdf)

We also offer a questionnaire specially designed for children with developmental disorders such as autism. This questionnaire may help identify present and past exposure of a child to environmental pollutants, especially mercury. Mercury is implicated by some researchers as a risk factor in the development of autism and other psychiatric disorders. The possibility that the child suffers from metal hypersensitivity will also be examined.

 

Pediatric questionnaire (fillable pdf)

Pediatric questionnaire (printable pdf)