We accept insurance for PPOs with out of network coverage. We do not accept Kaiser, HMOs, Medical or Medicare. Payment for services are expected and reimbursment will come depending upon your benefits, deductible and eligibility.
In order to submit to your insurance, please fill out your date of birth & address. Email the front and back of your insurance card to firstname.lastname@example.org. Ask your doctor to write a prescription to have neuro-feedback and infrared light therapy as needed due to your condition.
Indicates required field
Address (*Please fill complete address, city, state, zip)
Name of Insurance (indicate "none" if not using)
If none, specify none.
Date of Birth
What are you wanting to solve?
Anxiety & Stress Relief
Chronic Pain, Headaches, Migraines
Increased Performance & Focus
Rank each one you chose on a scale (1-10) 10 being the worst
How important is it for you to get past this issue?*
1 - Not Important
2- A Little Important
3 - Somewhat Important
4 - Important
5 - Very Important
6 - Super Important
7 - Seriously Important
9 - Extremely Important
10 - Life or Death
What medications are you taking?
Now from the items above list 3 goals that are most important to you.
PLEASE ADD ANYTHING ELSE YOU WOULD LIKE TO COMMENT ON HERE:
I don't know how I can pay for this, what are my options
I plan to use my insurance to cover
I want to be sponsored
I will pay by credit card, check or cash
I am not sure about payment yet but my health is #1 to me and I will figure out a way to make it work.
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