Neurofeedback -
Is It Right For You?

Neurofeedback - Is It Right For You?

Tell Us A Little Bit About Yourself

If you are struggling with the symptoms of ADHD or experiencing sleep problems, please complete the form below or call (631) 714-4100 to schedule a consultation to see if personalized Neurofeedback is right for you.

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Name*

First Last

Phone*

Email*

How Can We Contact You?*

Phone

If by phone, can we send you SMS Text Messages?*

Yes

When is the best time to reach you during the week?*

Morning

Afternoon

Evening

What Best Describes You*

If Other, please clarify

How'd you find out about us?*

If Other, please explain.

Please check if you answer, Yes.*

Are you experiencing inattention, impulsivity, hyperactivity problems or sleep problems?

Are you currently prescribed medications or have they been recommended for the treatment of ADHD/ADD or sleep problems?

Comments/Questions*

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