CONTACT US - NEUROFEEDBACK

contact us - Neurofeedback

At Polaris Consultancy we offer solutions for organisations and individuals seeking to enhance their personal or professional path, and unlock their full potential. As one of our core service offerings, Neurofeedback can be either stand-alone training or part of a comprehensive treatment program. The more information you can give us, the more our experienced staff will be able to help you. Polaris Consultancy will use your information for assessment use only. By filling in this form you are making an enquiry about our services and we shall not use this data for anything else but service-related communications. All information is strictly confidential.

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name *

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Email *

phone Number *

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What are the primary symptoms you want to address? *

physical, emotional or behavioural symptoms you would like to address? *

Are you currently under the care of a specialist or engaged in any medical treatment programs? *

If Yes, please specify *

HAVE YOU PREVIOUSLY BEEN UNDER THE CARE OF A SPECIALIST OR ENGAGED IN ANY MEDICAL TREATMENT PROGRAMS? *

If Yes, Please specify *

Have you ever had a head injury, received medical treatment following an accident or been hospitalised? *

if yes, please specify *

Are you currently on any Medication *

If Yes, Please specify *

Do you partake in the use of substances? *

If Yes, Please specify (This information is strictly confidential) *

Confidentiality *

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General Data Protection Policy *

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contact us - Neurofeedback

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