PostHeaderIcon A survey of individuals with MCS in Australia, 2011

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A survey of individuals with MCS in Australia, 2011

Complied by Dr Sharyn Martin 2014

pdf File: ASEHA 2011 MCS Survey


In 2011, ASEHA in cooperation with the South Australian MSC reference group conducted a survey of members with MCS as part of an attempt to draft MCS clinical guidelines. We felt it was important to gather specific Australian data on some key aspects of living with. The survey was intended to investigate aspects of Medical/diagnostic information; Impact and Burden of MCS of people’s lives, and what services are needed. The number of respondents was small at 50, but it does provide some insight into the lives of Australians with MCS.


Diagnosis and Duration of Illness

Duration of Illness


Development of MCS

Source/setting reported to be associated with the development of MCS

Stages of development

History of Inflammatory Conditions

Co-Morbid Diseases

Problems with medications, medical equipment, medical procedures


Impact and Burden of MCS

Level of support

Medical Assistance

Ability to Access medical and allied health services

Use of MCS hospital protocols

Work and Finance

Degree of Isolation

Degree of Disability


Services required to improve their quality of life

Identification for emergency Situations



Finding a pratitioner

Chemical Intolerance Screening Questionarre

Australian Hospital Guidelines


South Australia


Western Australia

Disability and Employment websites

Letters or paperwork that can be provide by GP or specialist to assist with non-medical issues



Diagnosis and Duration of Illness

Obtaining a diagnosis can be a difficult process and individuals can spend a lot of time, energy and finances seeking a practitioner with an understanding of environmental illness.  In our study we found that 74% of respondent had obtained a diagnosis of MCS from a medical practitioner. The ages ranged from 18 to 71, with a higher proportion of females than males responding to the survey.

Duration of illness.

We also wanted to determine how long they had the condition.  The mean duration of years with MCS was 22 years (min 2 to max of 71).  Fifty-two percent of those surveyed had had MCS for more than 20 years. This demonstrates the chronic nature of the illness.

Development of MCS

Source/setting reported to be associated with the development of MCS

The first figure (1) describes the Initiation of MCS. MCS is thought to develop through a twostep initiation process where the initial phase involves development of sensitivity to chemicals by either an acute high exposure or chronic exposure to lower levels of chemicals, followed by a triggering phase where the number of type of chemicals an individual reacts to increases.

Figure 3 Development of MCS

Figure 1 Development of MCS


The initialisation phase of development via acute or chronic exposure to chemicals can occur in several different settings each with the own unique chemicals and exposure pathways. Table 1 show the 5 main categories of settings where MCS is seen to develop. The first 4 categories are due to chemical injury as shown in Table 1 below.


Type of Exposure


a. Occupational

For example Industrial workers exposed to high levels of chemicals

Primarily male blue collar, 20-65 years

b. Occupants tight or problem buildings, (including schoolchildren),

Off-gassing of solvents and other indoor pollutants, and inadequate ventilation of buildings may play an important role.

More female than males, white collar office workers and professionals; 20-65 years, school children

c. Residents contaminated communities

Especially those residents living near toxic waste sites, close to industrial facilities, or with groundwater contamination

All ages, males and females, children and infants maybe affected first, middle to lower classes

d. Individuals with unique personal history of chemical exposure

Heterogeneous chemical exposures to things such as pesticides, domestic indoor contamination, consumer products, etc.

Females 70-80%, males 50%, 30-50 years, white, middle to upper classes and professionals.

e. Non-environmental

There are a small number of people who link the onset of their illness to “non-environmental” events such as major surgery, viral infection or a combination of the two

Table 1 Categories of setting where MCS is associated with the development of MCS


Source/settings associated with development of MCS

In this survey ninety-four percent of the respondents indicated that they knew or suspected the source/setting where their MCS may have been initiated. The majority of respondents, 54% indentified a single setting.  40% selected 2 or more settings.

Figure 2 shows that overall the majority of settings selected were where chemical injury was involved (60%). There were 42% Occupational cases, 32% cases from SBS, 34% with unique personal history of chemical exposure and 12% from contaminated communities and 40 % selected a non-environmental source.

Of the 20 who selected a non-environmental source, Category e, 12 cases were selected in combination with Chemical injury categories’ (a-d). Of the 8 respondents who selected a non-environmental source ( e) as a single cause, 2 were thought to be an escalation from CFS, 2 were genetic component (2 siblings of MCS mother) , one case of each flu vaccination, viral origin and pregnancy.

Figure 2 Settings involved in the development of MCS

Figure 2 Settings involved in the development of MCS

The list of chemicals involved in chemical injury cases where noted included Nursing chemical, Laboratory chemicals, Pesticides, Tannery chemicals, Art Supplies (teacher), Plastics emissions, Spray painting, Household chemicals, Hairdressing chemical, Solvents, Diesel fuel, Agricultural chemicals and Pharmaceuticals (eg vaccines, anesthetics).

Stages of development

Similarities in medical history

There is evidence in scientific and medical papers that a history of unresolved inflammatory conditions maybe a marker/precursor to the development of MCS.  History of non allergic irritant diseases such as rhinitis, asthma, reactive airways dysfunction syndrome (RADS), reactive upper airways dysfunction syndrome (RUDS), reactive intestinal dysfunction syndrome (RIDS), Vocal Cord Dysfunction (VSD), food allergies/intolerances  have been reported in patients with MCS. This suggests that MCS may develop in stages such as those shown in Figure 3


Figure 3 Stages of MCS Development

Figure 3 Stages of MCS Development

By intervening early with chemical avoidance strategies can restore a limited amount of ability to tolerate environmental chemicals. Continued exposure to low levels of chemicals causes symptoms to fluctuate and maintains a continuous sensitised state. Early measures are likely to make a difference as once MCS escalates difficult to manage and enter into community and the associated social problems.

We asked respondents whether they had had a history of inflammatory conditions, either allergic or non-allergic mechanism, and prior to the development of their MCS.  The results are shown in the next figure (4). We found that the majority of respondents 88% reported having prior allergic &/or non allergic conditions. Only 12% of respondents reported no history of an inflammatory disease.


Figure 4 Medical history of Inflammatory Conditions

Figure 4 Medical History of Inflammatory Conditions

Co-Morbid Diseases

There are a number of studies on the association of MCS with CFS, fibromyalgia, food sensitivity and allergy. There is an overlap of symptoms between MCS, SBS, CFS and fibromyalgia. Studies have found that up to 42% of people with CFS also have MCS and subjective intolerance to low level chemicals is a common symptom in people with CFS, fibromyalgia and Gulf War Syndrome.  Fatigue is a common symptom among those with MCS, whether the chronic fatigue came first or the MCS may be the difference in diagnosis.

In our survey the most common co-morbid diseases reported were CFS/FM, gastrointestinal and skeletomuscular disorders as shown in figure 5

While many of the co-morbid conditions that exist with MCS carry a significant burden of disability, MCS alone can pose major functional impairment for those affected, and they can experience profound difficulty doing day to day tasks.

Individuals with MCS usually have other diseases, some of which are chronic, painful and disabling that may require medical intervention.  These conditions can be missed or left untreated if the individual does not have a GP who understands MCS.


Figure 5 Co-morbidities

Figure 5 Co-morbidities

Problems with medications, medical equipment, medical procedures

The final question in this section was to investigate the rates of intolerance to medication &/or medical procedures/devices in our survey population and compare this to rates cited in overseas literature. Adverse drug reactions to medications, both over the counter and prescribed, are frequently reported by those with MCS (approx 25% - 75% ). Two American researchers Ashford and Miller suggest that an overlap exists between people who react to medications and those with chemical sensitivities.  Reactions maybe to the active ingredients or any one of  the inert  ingredients also in medications such as flavours, colours, preservatives and excipients  such as cornstarch or lactose in tablets, mineral oils.

In our survey we found that 81.6% of respondents have problems with medications, medical equipment and medical procedures. The main problems were reported with anaesthetics, medical dyes, medical equipment, antibacterials, plastics and adhesives. These results appear to conform to MCS patterns seen in medical literature.

To summarise:

  • 74% had a medical diagnosis of MCS
  • The mean duration of the illness was 22 year (min 2 to max 71)
  • The most identified setting involved with initiation of the condition were those where chemical injury was involved
  • 88% reported a prior medical history of allergic and non-allergic inflammatory conditions
  • The most common co-morbid diseases were CFS/FM, gastrointestinal, allergic, cardiac, ENT and skeletomuscular disorders
  • 81.6% reported problems with medications, medical equipment, and medical procedures.




The next part of the survey was designed to investigate the impact and burden of MCS on sufferers lives as shown in figure 6. The following figure represents the areas that impact an individual, which can have a flow on effect increasing the burden and influencing the disability and isolation.  Individuals with MCS can have limited functioning and health related quality of life.

Depending on the degree of disability it can be difficult to work and care for homes and families. The combined negative impact from issues with Work & Finance; Medical & Social Services care, low social/community support and lack of safe affordable Housing can have a compounding negative effect on sufferers.

The factors that impact a person with MCS quality of life are: Barriers to medical and allied health services, Lack of medical assistance, low community/social support, lack of safe affordable housing, inability to work and financial hardship and the living adjustments required to live with MCS. These create and perpetuate the personal distress that affects the degree of isolation and disability.

Figure 6 Impact and Burden of MCS

Figure 6 Impact and Burden of MCS

In this survey we evaluated some of these aspects:- The level of support from family, friends and medical practitioners; the ability to access medical and allied health services; ability to work or receive pensions and finally the level of disability and isolation.

Level of support

We found a number of individuals lacked support from family and friends. This can often be due to scepticism by family members or friends and can affect the individual’s ability to socialise becoming another burden that adds to the personal distress. Figure 7.


Figure 7 Support from Family and Friends

Figure 7 Support from Family and Friends

Medical Assistance

The lack of support or understanding from a medical practitioner delays effective treatment and management and does not dispel the disbelief by others. Finding a helpful/sympathetic GP or other medical specialist is important for:

  • Accurate diagnosis
  • Management and treatment of the condition
  • Access to other allied health and social services
  • Validation of the condition to allow the patient to be able to make the necessary changes and enlist the help of families, friends, and co-workers etc.
  • Avoid the ‘medical merry-go-round’ of consulting a wide variety of  GPs and specialists and undergoing a range of diagnostics tests and treatments in order to obtain a relevant diagnosis

In this survey, 42.6% reported that their GP is helpful, 29.8% as sympathetic with 27.7% neither helpful nor sympathetic. For some the lack of medical support has meant that they have not been unable to access social or disability support. They are unable to qualify for services or having their cases rejected due to lack of medical support.

Pam Gibson a researcher in the USA in a study in 2000 investigated the services requested and received by consumers with MCS found that MCS individuals saw on average nine medical practitioners each. Only twenty-seven percent of these were reported to be helpful. As Environmental Sensitivities are not routinely diagnosed in General Practice, it can be difficult for people to find medical practitioners with an understanding of MCS.

Ability to access medical and allied health services

The primary stop for people with medical problems is the GP. It is difficult enough to find practitioners who are able to help, without the added problem of becoming disabled when attempting to attend medical and Allied health facilities. Individuals with MCS can be disabled by chemical barriers when entering buildings and offices. The barriers include the wearing of perfume by staff and use of fragranced products, air fresheners, pesticides, cleaning products, paint, or the choice of building materials. All of these can significantly contribute to indoor air pollution to the degree that a chemically sensitive patient can become profoundly disabled after entering the building.

We asked respondents if they had difficulty accessing Health services, Allied Health Services, Disability & social services and Aged Care facilities, figure 8.


Figure 8 Acces to Health Services

Figure 8 Access to Health Services

Regardless of the facility, in this survey were found that >55% of respondents reported not being able to access these services as can be seen in the next figure. Those who could state that they couldn’t access the services safely or could only stay for short periods of time. The main barriers given for the inability to access these services were Poor Indoor air quality (22); ubiquitous nature of perfumes (17); use of indoor chemical pest control (3); unable to meet strict criteria to access auxiliary services and/or financial hardship (3). Indoor Air Quality issues include contaminants such as perfume and pesticides. Fragrance is the most troubling chemical and least necessary barrier to health services.

Poor indoor air quality is a major detriment to MCS/ES disability access to most public buildings including hospitals and other health care facilities. Many are unable to access the necessary services and care.

Hospital Protocols. We asked respondents if they knew of  Australian MCS Hospital Protocols and if they had attempted to use these protocols when in a hospital.(Figure 9). Fifty-three percent of people had heard of MCS Hospital Protocols. Thirty-eight % (10 people) who knew of MCS Hospital Protocols had attempted to have them implemented. Despite these protocols being available 66.7% (6 people) found them to be unsatisfactory.


Figure 9 MCS Hospital Protocols

Figure 9 MCS Hospital Protocols


Work and finances We asked respondents whether they are able to work or if they have received a pension.

Figure 10 shows that a high % of respondent was unable to work (68%).  A lack of financial security adds to the personal distress and can place extra strain on relationships and families. Of those able to work, 1 worked from home and another stated it was difficult as she was not able to work in closed buildings, or requiring an opened window in the area.

Figure 10 Work and Finances

Figure 10 Income

We found that of the 8 who were not working and not receiving any pension, 3 of these noted that they have a working partner.   Of the 42 receiving a pension, 13 were Aged care, 19 were Disability and 3 were unspecified. It is reasonable to assume that the 13 receiving Aged pensions may be nearing a requirement for placement in an Aged Care Facility. From the previous data were found that of the 31 who responded, 27 (87%) reported that they were unable to access Aged Care Facilities. This will become a greater issue as more come to retirement age. In this population, 52% have had MCS for 20 years or more, most probably contracted during their active working life.

Degree of Disability

Individuals with MCS suffer general disability with symptoms and health problems. This is combined with the disability that results from exposure to chemicals that are ubiquitous in the environment and extremely difficult to avoid. Figure 11 demonstrates the high degree of disability reported, with 96 % experiencing significant (medium 44%, high 52%) disability with only 4% not disabled at all. The 52% reporting high level of disability would require assistance with many aspects of their life including shopping, banking and dealing with other attendant issues.  For some there did not appear to be much support two stating that their partners had left due to the strain of dealing with MCS. Unemployment is usually accompanied by financial, social and psychological losses.

Figure 11 Degree of Disability

Figure 11 Degree of Disability


Degree of Isolation

Isolation occurs when MCS becomes so severe the patient loses the ability to leave home to go shopping, go to church, go to the beach, park, take part in some form of entertainment, visit the doctor or the dentist. Individuals stop going out to avoid the disabling symptoms experienced when exposed to commonly used chemicals. These are ubiquitous in the indoor air of many public built environments. The need for an early diagnosis of chemical sensitivity, identification of chemical(s) involved and avoidance strategies put into place is paramount to preventing the problem from evolving into MCS and the severe form of the disease.  MCS patients should always be encouraged to move around in society as much as possible to avoid isolation.

Isolation also happens when family and friends withdraw support because they either do not believe the MCS patient or they can no longer deal with the MCS lifestyle that is based on avoidance and special need.  In many cases families and friends are not prepared to take the necessary such as to be fragrance free during.

In our study, Figure 12, we found an elevated degree of isolation 50% high, 38% medium with only 12% reporting low isolation.

Figure 12 Degree of Isolation

Figure 12 Degree of Isolation


To summarise the impact and burden data

  • A high number of individuals were unable to access health services including Aged care facilities. This is becoming an issue as the MCS population ages.
  • Low levels of support from friends
  • The  majority of individuals were unable to work
  • Without prompting 16 noted that assistance with low allergy housing was needed.
  • The resultant disability (94% partial to total) and isolation (88% medium to high) indicates a need in the community which is not being meet.

It is important for service providers to know the significance of environmental sensitivities in order to help and accommodate persons who experience them. Providing appropriate work accommodation could improve workplace retention and quality of life for people with disabling sensitivities.   This may be as simple as making a fragrance free environment by engaging in education of staff that fragrances are solvent based products, they can be dangerous and can significantly contaminate indoor air.

The Message is To Recognise early and Implement measures to ameliorate it and prevent escalation. While diagnosis by a medical specialist is important for the reasons mentioned above, some measures to reduce exposure to potentially harmful chemicals can be done although much harder without medical recognition.




The last part of the survey identifies what those with MCS feel they require to assist them in improving their quality of life, Table 2. A high priority is this survey was air filters.  These help in reducing the amount of pollution in the immediate area depending on the size and capacity of the filter. In some cases more than one filter is required and this can become very expensive with no rebates or assistance with their purchase. A car air filter can facilitate a safe haven for those needing to travel to shopping areas or health facilities. Other aides include water filters, personal masks that can be worn to avoid chemical exposures in indoor air, and oxygen for use during high exposures or recovery from an exposure. Other areas were for assistance with daily chores such as shopping, house work, and home maintenance. These can be either too physically demanding or involve exposure to contaminated environments. Living conditions was also an area of concern with needs for safe housing, respite accommodation and an advocate/carer. Unfortunately people disabled by chemicals are not recognised as disabled.


ASEHA Survey Responses

Service Needed

Number of respondent

Air Filter




Water Filter






Low Allergy Housing








House Maintenance


Lawn mowing


Organic food


Respite Accommodation




Aged Care










Nutritional Supplements






Safe cleaning products


Table 2 Services needed by individuals with MCS

I would like to add to this access to computers and the internet. These can reduce the feeling of isolation and allow people to investigate products and aides to assist with creating a safe environment as well as staying in contact with other people. Support groups can provide pertinent information and advice as well as companionship and sense of community.

Identification for emergency situations

The last question was to determine if individuals felt that they needed identification for emergency situations. We did this by asking participants if they felt they needed a MedicAlert Bracelet. The MedicAlert system is in case of an accident, if you are unconscious or confused and cannot provide necessary medical details. Just over half of the respondents felt that they needed this form of identification as seen in Figure 13.

A major concern for those with MCS is what to do during an unavoidable disabling exposure to chemicals. The effects can be physically disabling as well as feeling of disorientation and reduced functioning. These are circumstances where you are unable to communicate clearly with those trying to assist.

We also asked whether they had obtained one and if they had occasion to use it was it effective. A small number had been able to obtain one. Of the 7 who had occasion to use them only 2 found them of benefit.   There were a two people who stated that they didn’t bother applying for Medicalert as they had been told by Ambulance Officers that they administer aid according to their protocols and would be unlikely to phone for information from medicalert  systems


Figure 13 Medic Alert Responses

Figure 13 MedicAlert responses


An alternative to a Medic Alert system, is to prepare your own card to carry in your purse or wallet, shown below. This can be given to people trying to help you in these situations. Lucinda has prepared cards for people with MCS or the following example may provide a template for creating your own with your specific details.

Just try to keep it as simple as possible

The card should have

  • A contact name and phone number. Either a Family member, Friend or GP
  • What your major problems are
  • What you need assistance with

For Example

PLEASE CONTACT (your GP if you have one OR friend/family who understands your situation) Contact Details -  Ph number:


I REACT STRONGLY TO MANY COMMONLY USED MEDICATIONS (Important if you are likely to be taken to a hospital or medical surgery). List your major ones to avoid)






MCS is a chronic disease with an average of 22 years duration and carries with it a high degree of disability and isolation. We found a high degree of unmet needs in the MCS community most prominent of which is the barriers to accessing services

Individuals with MCS disability have no opportunity to improve their lives, their health or take part in society AND are often unable to work to support themselves. They lose the support from family and friends and can become isolated.  Income support from welfare services is insufficient to provide for their special needs in housing, disability aids, medical aids. Food and nutrient support is often required as food allergy/intolerance is often a coexisting factor along with inability to take many medications.  Some need extensive home modifications made to reduce levels of mould and VOCs in the home environment.  Disability accommodations need to be made safe for the chemically sensitive. This applies to hospitals and other health care facilities, in-home services, emergency services, aged care facilities and the workplace to allow disability access without discrimination.  This may be as simple as making a fragrance free environment by engaging in education of staff that fragrances are solvent based products, can be dangerous and can significantly contaminate indoor air.

MCS is a hidden disease. Sufferers are often isolated from friends, family and community by their illness. I hope that by gathering and disseminating information that highlights these problems it will raise awareness of these issues and the unmet needs of those with MCS.


Targeted educational programs are required to promote awareness of MCS amongst service providers including Complementary Medicine practitioners about the need for safe non-perfumed environments. There is also the need for education regarding the dangers of exposure to commonly used chemicals and the relevance of these to a MCS person’s life.

Prevalence Data

One of the most important issues at the moment is to determine the number of individuals with MCS to demonstrate a need in the community. Political change requires numbers, hard facts and real figures. When negotiating with the government and/or government departments, they need to know how many people are affected. The more facts we can provide, the easier it will be for decisions to be made.

The formation of an Australian national register will illustrate the need for change with actual numbers. Lucinda Curran, Dr Ian Buttfield and myself, Sharyn Martin, have made available a website where such data can be collected .  The data collected by ANRES will kept private and secure.


Finding a practitioner.

Physicians. At the moment the difficulty faced by GPs is that there are no guidelines on diagnosis, treatment or management of environmental sensitivities. There is limited knowledge of MCS and other related conditions such as CFS, fibromyalgia and food sensitivities and they are not covered in main stream medical school training or Continuing Medical Education programs. However there are a number of practitioners who have undergone ACNEM (Australasian College of Nutritional and Environmental Medicine) post-graduate courses and workshops in the application of the principles of Nutritional and Environmental Medicine.

Complementary medicine practitioners can also help with the condition without the use of medications. It is a matter of finding a modality that best suits you.

Australian Site: The Australasian College of Nutritional and Environmental Medicine (ACNEM) has an Australian & New Zealand referral list.  There are a few overseas listings for Hong King, Japan, Malaysia, Netherlands and Singapore. This site lists GP's, Dieticians, Pharmacists, Dentists, Chiropractors, Naturopaths as well as some other health care professionals.

Overseas Sites The referable physicians listed on this American site are members of the American Academy of Environmental Medicine (AAEM). There are lists for US states and some other countries - Australia, Belgium, Bermuda, Canada, England, Germany, Japan, Monaco, New Zealand, Norway, Puerto Rico, Singapore and Switzerland. MCS Referral & Resources Website. This American Website is maintained by a non-profit organization engaged in professional outreach, patient support and public advocacy devoted to the diagnosis, treatment, accommodation and prevention of Multiple Chemical Sensitivity disorders. The organisation is based in Baltimore MD. Chemical Injury Information Network. CIIN is a non profit organisation based in White Sulphur Springs, MT. CIIN provides Doctor referrals to their members. This website has links for American medical treatment centres.


Diagnostic Aide : The Quick Environmental Exposure and Sensitivity Inventory (QEESI) from

Chemical Intolerance Screening questionaries. Diagnosing a person with MCS requires a detailed medical and environmental history. The Quick Environmental Exposure and Sensitivity Inventory (QEESI) is a standardised and validated screening questionaries that is readily available for download. It can be employed to obtain a profile of a patients’ self reported symptoms and intolerances. The Inventory provides information on a patients Symptom Severity, Chemical intolerances, Other intolerances and Life impact. The Inventory can be used as a diagnostic tool and as a baseline to monitor a patients’ progress over time.

This investigation is readily available, easy to administer and interpret. It can be downloaded from the link shown in the slide or search for QEESI on a search engine. Individuals with symptoms of chemical intolerance can take the completed inventory  and the interpretation sheet to their doctor.

It can also be used to observe and note down when exposures and symptoms occur in different settings and conditions. Exposures between home, work or other environments (holidays) can then be compared.

It is also legal to use for medical practitioners.  The QEESI may be downloaded from


Australian Hospital guidelines for MCS. There are currently four  - available in SA, WA, Vic and the ACT.

Australian MCS Hospital Guidelines can be found from the following links

Victoria 2011:

South Australia 2010:

ACT 2012:

Western Australia:$file/4445.pdf


Disability  and Employment Issues in Australia

Australian Occupational Health and safety Union Reps :

Disability employment. The Australian government website for disability Employment access website is

Australian Disability Clearing House on Education and Training.


Letters or paperwork that can be provided by GP or specialist to assist with non-medical issues

GPs can assist by providing letters or paperwork required for services such as social and disability welfare.

  • In-home support
  • Carers
  • Unemployment benefits
  • Sickness benefits
  • Disability support. In Australia, we are struggling to have MCS/ES recognised as a physical condition.  Our Human Rights Commission recognises MCS/ES and fragrance sensitivity as a disability if it can be shown that an individual has the problem.
  • Compensation payments for workplace injury
  • Referral to specialists, physiotherapists and OTs etc – MCS patients are likely to have other chronic health issues that require specialist care or other type of intervention.
  • Government Housing suitable for allergy/MCS patients (sample letter for housing on website)
  • Home schooling
  • Disability parking
  • Assistance with medical aids e.g. wheel chair, oxygen at home
  • Aged care or respite services
  • Pain management services
  • Chronic illness/loss/grief counseling
  • Social workers
  • Rehabilitation
  • Ambulance transport services

Last Updated (Monday, 27 June 2016 03:38)