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Provider Patient Referral form

To refer a patient to BrainHealth, please fill out the HIPAA compliant form below. You may also download the referral form and fax to 1-877-766-3950 or upload here.

BrainHealth provides actionable science-based programs and feedback for those at risk or in the early stages of cognitive impairment. We offer:

  • Risk assessment + consultation
  • APOE genetic testing
  • Personalized lifestyle coaching
  • Biomarker testing
  • Referrals to specialists
  • Ongoing support