Brainstorm Intake Contact Form
It is our pleasure to welcome you to Brainstorm. Please complete the following questionnaire. Your answers will help us to determine whether we can help you and your family. Please allow 10-15 minutes to complete this comprehensive health questionnaire.
The next step ( after completing the Intake Contact Form) is a review of your responses to determine a valid pathway or approach. Our comprehensive examination detailing your general and neurological health may be arranged. This consultation appointment will follow with an interview or conference style consultation designed to outline and discuss appropriate co-management or therapeutic strategies. Please note the fee schedule for the initial visit is inclusive of the initial consultation and conference consultation both at two separate time allotments.
Please note this information is strictly confidential.
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This form was created inside of Coastline Chiropractic Centre.