Doctor Recommendation Form
Please fill out this form in order to better help us find the right match for you with a Functional Neurology provider, or other healthcare professional.

You will receive a notification to schedule a complimentary phone call with Dr. Shane Steadman at Integrated Brain Centers, who will help match you with the best doctor based on your location and symptoms.

Keep in mind that most non-traditional modalities are not covered by insurance. Some insurance companies will reimburse you for some of your treatment, but you will need to submit to them directly.
Full Name *
City/State/Country *
Phone Number *
Email Address *
When was your injury? *
What are your primary symptoms/concerns? *
What types of providers have you already worked with? *
Are you willing to travel? *
Additional comments *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy