REQUEST A CONSULTATION WITH THE GAME CHANGER
Complete the form below as accurately as possible. Please allow 24 hours for response.
If your matter is urgent, please call 647-688-2216. If you're in an emergency situation please call 911.
Who is this Session for?
The 3 major problems with your Brain and/or Health
The 3 major problems in your Career and Life
What are the Outcomes that you are seeking?
Existing Medical Conditions:
Most prominent problems (please rate from 0 to 10)
List childhood injuries, falls, concussions (MTBI)
List any medications taken in the past (age?)
List Therapies and Treatments you’ve tried:
On a scale of 1 to 10 rate how successful these treatments have been. 1 - no difference. 10 - very successful.
Anything else you would like us to know?
What are you Seeking?
1-on-1 Online Brain & Body Mastery Session with The Game Changer
Book a QEEG Brain Mapping & Neuro-Assessment
Book a Session at The Game Changer Practice
Please Check all that apply
Lack of Focus
Physical Health Issues