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.
Brain Injury Symptoms Checklist
The starting point of your entire intake. One guided session covers your symptom history, accident details if applicable, and all required consent forms — signed and submitted in one sitting. When you're done, there's nothing left to complete.
- Symptom severity assessment, organized by brain region
- Accident & mechanism details (for MVA / personal-injury patients)
- New Patient Authorization — pre-filled and e-signed
- HIPAA Agreement — reviewed and e-signed
- Confirmation email with your brain-map prep guide
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?
Prepare for your visit
Read these before your qEEG brain mapping session so we capture the cleanest, most accurate map of your brain.
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.
Accident Intake Paperwork
Detailed intake for personal-injury and motor-vehicle-accident patients, including incident and symptom history.
Medical Referral & Order Form
FillableThe 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
FillableFor 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-signHow insurance, attorney liens, and out-of-pocket options apply to your care at Neuron Connect.
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.
Your privacy is protected
All neuro-assessment data is handled under HIPAA.
Ready to start?
We accept insurance, attorney liens, HSA, ESA, and CareCredit. Financial concerns should never delay your care.
View Ways to PaySchedule 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.