Please fill out the Brain Health and Nutrition Assessment Form (BHNAF) and the Brain Function Assessment Form (BFAF) if you have a psychiatric problem (Behavior), a neurological problem (Brain function), or an adrenal problem (Stress/Fatigue) AND have a family member fill them out additionally.

You can also fill these out if you want these systems evaluated alongside your health concerns. More information is always welcome.

Instructions for this Page:
  1. Download the Brain Function Assessment Form to your computer.
  2. Open and fill out the form.
  3. To save the form with your answers, click on either:
    • Download (Hover over the top right corner of the browser screen) or
    • Right-click in an empty space on the page and choose File – Save As from the context menu and choose a location to save on your computer.
      Download Image      Save As image
  4. Fill out the Name and Email fields below.
  5. Click the “Choose File” button.
  6. This will open a window to browse to where you saved your form.  Click on the form and then click on “Open” or “Okay”.
  7. Once your file has uploaded, click on “Submit and Continue” below.
  • Accepted file types: pdf.
  • This field is for validation purposes and should be left unchanged.