First Name
Last Name
Date of Birth
Email
Phone
Gender MaleFemaleOther
I am between 18-69 years old truefalse
I do not have a history of claustrophobia truefalse
No history of breathing disorder truefalse
I do not have a permanent retainer truefalse
I do not have any implants that contain metal truefalse
I weigh less than 250lbs (to accommodate the fMRI table) truefalse
I do not have tattooed makeup (includes microblading) truefalse
I commit to completing online training & assessments truefalse
I commit to coming in person for the fMRI scans truefalse
How did you hear about us? Instagram Facebook Through a Friend BrainHealth Event Other
Comments
*By clicking submit, your information will be used to inform you of news related to The Center for BrainHealth that we believe would be of interest to you.