New Patient Intake Forms

Based on your chief complaint, we have a specialized client application for you to complete. Please call our office to receive either a form you can fill out via computer or a hand-written form based on your choice.

Call our office to reserve your appointment. (586) 488-4818

NOTE: The brain mapping fee is paid at the time of appointment reservation.

Our staff will email the appropriate intake forms to you.

In compliance with HIPAA regulations, you can send us your Protected Health Information (PHI) via our secure portal.

Brain Mapping Hours

In order to secure the highest quality test results, brain mapping is only performed in the morning. Our testing schedule is as follows:

Monday, Wednesday, and Thursday from 9:00 am – 11:30 am

Patient Financing Options

Care in our office is considered ELECTIVE and not covered by insurance

We offer a single payment discount or low monthly payments through Care Credit. You may qualify for interest-free options based on your credit score. No application fees.

No Surprises Billing Act

You have the right to receive a “Good Faith Estimate” explaining how much your health care program will cost

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

  • You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit