NeurOptimal system rent

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Thank you for deciding to rent NeurOptimal system.

Please complete this application and we will contact you to agree on timing of receiving and handing over the equipment!

Name, Surname *

Phone number *

E-mail *

Did you or any body of your closest people have previously visited RigaBrain or NeurOptimal sessions? *

Yes

Other:

Which option will you choose? *

From which date would you like to start rent? *

Preferred time for receiving and passing the computer:

Why do you decide to rent a computer? *

I want to get a computer *

In RigaBrain office in Riga, Latvia

With a courier! Paying for packing, shipping and insurance (If you choose this option, kindly write the delivery address below.)

Delivery adress

I want to return the computer *

In RigaBrain office in Riga

With a courier! Paying for packing, shipping and insurance

Other:

Training *

I rent repeatedly and there is no need for training

During receiving a computer at RigaBrain office in Riga. Time - 1.5 to 2h, price - 50eur (RUS, ENG or LV)

Handouts (ENG) or Learning Video (ENG) that will accompany a computer

Before receiving a computer - Phone, Whatsap, Zoom etc. Price - 30eur

Other:

Insurance
*

Not required

10.00 EUR per day, required

30.00 EUR per month, required

Sessions will be guided by me for: *

Family

Parents

Friends

Collegues

Neighbors

I will charge for sessions from other people

Other:

Required

Is there any person who advised you to rent this system?

Process evaluation
*

Not required

Process assessment – 50 EUR per person. RigaBrain® conducts a pre-session survey and questionnaire. After the sessions, a discussion is held about the session results (both subjective and objective). A minimum of 10 completed sessions and at least 30 days from the first conversation are required.

Indicate the name and surname of the person(s) who will require the process assessment.

Contract

Renting for the first time, a contract is required.

Renting again, a new contract is not required.

Renting again, a new contract in another person's name is required.

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