Health and Wellness Background
Have you been diagnosed with or are you currently experiencing any of the following conditions? (Check all that apply)
How would you rate your current stress levels?
(1 being very low, 10 being very high)
Support and Accountability
How do you prefer to receive support and communication during the program?
By completing and submitting this form, you agree to participate in the Brain Retraining Program under the guidance of
You understand that this program is not a substitute for professional medical advice, diagnosis, or treatment.
