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Neuron Connect — Brain Mapping & Neurofeedback
Patient intake

One checklist. Your entire intake, handled.

Complete our Brain Injury Symptoms Checklist and a single guided session handles everything else — accident details if you were in an MVA, all consent forms signed, and a confirmation email with prep info. Nothing left to print or bring.

Start here · your complete intake in ~10 min

    Individual Forms & Downloads

    Already completed the checklist? You're all set — no further paperwork is needed. These documents are available if you need a specific form on its own, want a PDF copy, or weren't able to finish the guided flow online. Prefer to complete on-site? Please arrive 15 minutes early.

    Looking for a specific form?

    Before your visit2 documents

    Prepare for your visit

    Read these before your qEEG brain mapping session so we capture the cleanest, most accurate map of your brain.

    Brain-Map Preparation List

    What to do — and what to avoid — in the hours and days before your brain mapping appointment.

    Tips for Best Results

    Simple steps that help you get the most from your assessment and your time at Neuron Connect.

    EnglishEnglish only
    Individual paperwork8 documents

    Patient paperwork & legal

    Individual documents, available if you need one on its own or want a PDF copy. Most patients won't need these — the symptoms checklist online handles all required paperwork in one session.

    New Patient Authorization

    Required

    Authorizes Neuron Connect to begin your evaluation and care. Required for every new patient.

    HIPAA Agreement

    Requirede-sign

    Our notice of privacy practices and your acknowledgment of how protected health information is handled.

    Accident Intake Paperwork

    Detailed intake for personal-injury and motor-vehicle-accident patients, including incident and symptom history.

    Patient Lien Agreement

    e-sign

    For attorney-lien cases — lets us begin treatment now and bill the settlement later, with no upfront cost.

    Physician / Nurse – Patient Arbitration Agreement

    e-sign

    Explains how any disputes between you and your care team would be resolved.

    Medical Referral & Order Form

    Fillable

    The physician script pad — a referral and order form your physician completes to request a qEEG brain map, neurofeedback therapy, neurology, or neuro-psychiatry care.

    Brain Map Clinical Referral & Order Form

    Fillable

    For personal-injury and accident cases — physicians and attorneys use this order form to request a qEEG brain map, neurofeedback therapy, or trauma counseling/EMDR.

    Insurance Disclaimer

    e-sign

    How insurance, attorney liens, and out-of-pocket options apply to your care at Neuron Connect.

    EnglishEnglish only
    Optional1 document

    Education & sample reports

    Helpful reading so you know exactly what to expect from brain mapping and what your results will look like.

    Sample qEEG / TBI Education Report

    A real, de-identified sample brain-map report so you can see the kind of results your assessment produces.

    EnglishEnglish only

    Your privacy is protected

    All neuro-assessment data is handled under HIPAA.

    Ask a question

    Ready to start?

    We accept insurance, attorney liens, HSA, ESA, and CareCredit. Financial concerns should never delay your care.

    View Ways to Pay
    Ready to begin?

    Schedule your first appointment today.

    Complete your intake forms online and our patient coordinator will reach out to confirm your first brain mapping session. No upfront cost on attorney-lien cases.

    Attorney-lien friendly. Se Habla Español. Multiple Arizona locations.