📄 Paperwork to print off (if needed) - Email to info@cognitiveorganics.com

Fill out the following referral form 📝

or

Print the paperwork 📄 with your client

— no need to do both!
We’ll contact the client to help them get scheduled either way. 🤝

 

Curious about LENS Neurofeedback?
✨ Give your client a quick peek: cognitiveorganics.com/lens-brief
🔍 Want the deep dive? Head here: cognitiveorganics.com/lens-neurofeedback

Fill in the form below to complete the referral:

Referral Form

Your Name (Referring Person)
Name of who you are referring
Put child's name if that will be the client
Adult Name if client is a minor
What are you referring them for?
What office would be closest to the client
Max. file size: 1 GB.
Consent & Authorization