Children's Brain TheraCamp™- a pre-screening online call registration

request a Brain Test form before your call

Name *

Parent/Guardian Name: *

Email address *

Best Contact Phone Number: *

Time Zone: *

Child's Age: *

Child's Current Diagnosis (if any): *

How did you hear about the Brain TheraCamp™ Intensive? *

What is the single biggest, most frustrating struggle you are trying to solve right now? *

What solutions (therapy, coaching, meds, supplements) have you already tried, and what was the result? *

On a scale of 1 to 10, how determined are you to access a definitive, rapid, root-cause solution for your child? (Scale: 1 = Casually Exploring, 10 = Ready to Start Immediately) *

The Brain TheraCamp™ Intensive focuses on fixing the hardware (brain function), not just managing the behavior. Do you agree that addressing the foundational brain imbalance is the missing piece? *

Yes, I am fully committed to a root-cause approach;
No, I mostly want behavior strategies

The Brain TheraCamp™ Intensive is a high-level, specialized program requiring a significant financial investment. Are you prepared to prioritize an investment in this range for a rapid , sustainable solution for your child? *

Yes, I have the financial authority and resources.
I need to consult with a partner/spouse.
No, this investment level is currently beyond our budget.

If we determine the Intensive is an excellent fit, are you prepared to move forward with scheduling the Full Functional Neurology Assessment and Brain TheraCamp 10h intensive within the next 7 days? *

Yes
No, I need more time