EMF Exposure & Mitigation Intake

Contact & Consent

Full name

Email

Phone (optional)

City, State/Region (optional)

I consent to share these responses for engineering analysis. This is not medical advice.

Clinic / Practitioner (optional)

Route your intake directly to a practitioner or clinic. Select from the list (if available) or enter a Practitioner ID.

Select practitioner

Or enter Practitioner ID

Home Wi‑Fi / Router

Mobile & 5G

Cell carrier(s)

Hold Ctrl/Cmd to select multiple.

Typical signal bars at home

Primary phone

Overnight phone behavior

Bluetooth wearables / accessories

Earbuds Headphones Smartwatch Fitness tracker Hearing aids (BT) Car Bluetooth (always on) None

5G type in your area (if known)

Nearby Cell Infrastructure

Nearest cell site distance

Cell site type (if known)

Smart Home / IoT

Sleep Environment

Nighttime environment

Phone near bed Wi‑Fi left on Bluetooth wearables on Smart devices in bedroom Shielding (canopy/paint) Kill-switch for circuits None of the above

Top sleep goals (choose up to 2)

Hold Ctrl/Cmd to select multiple.

Work / School

Typical setup

Seated within 10 ft of access point High-density Wi‑Fi (many APs) Indoor cell booster/DAS Laptop on Wi‑Fi all day Ethernet available Use wired headset for calls None of the above

Vehicles

Vehicle type

Bluetooth in vehicle

Home EV charger distance from sleeping area

Wearables / Medical

Wearables used

Smartwatch (always on) Smartwatch (only for workouts) Fitness band Oura/Whoop ring Medical implant (e.g., pacemaker) None

Tools & Mitigation

Priorities

Your top 3 goals

Lower bedroom RF Safer phone habits Reduce smart-home emissions Wired internet transition Workplace setup Measurement plan

Other notes (optional)

Review & Submit

Score: 0 Band: n/a

Top suggested actions: