Member Resources

Forms:

Feel free to print and fill out the documents below and bring them with you to shorten paperwork time. Note: The forms are used for different services; if you have any questions on which to fill out, call the office at 316-260-9005.

Comprehensive Executive Assessment Questionnaire  – (Dr. Seberger only)

Child Information Form
Adolescent Information Form      (Child, Adolescent, and Adult forms are for Neurofeedback Only)
Adult Information Form

Symptoms Checklist (Only if requested by Dr. Seberger) 

Helpful Links:

We invite you to take the AARP Brain Health Assessment to get your Brain Health Score and a detailed report that will provide insight into how your brain works and how your lifestyle supports important cognitive functions like memory and focus. The assessment is free and we encourage you to print out your results and bring them in on your next visit!   Click Here –> Brain Health Assessment

 

 

Dear Patients of Cognitive Performance & Health,

As patients of Cognitive Performance & Health you may now establish an account with XYMOGEN® either by calling Customer Service at

1-800-647-6100 and indicating that you have been referred by us, or via the XYMOGEN® website. A separate Customer ID will be assigned to each patient. This will allow you to purchase supplements online for retail price and have them conveniently delivered to your door.

For your convenience, a REFERRAL CODE will be given to you. This will allow you to create your own account on XYMOGEN.com without having to call into the Customer Service Department. To receive your code, please call our office at

1-316-260-9005

Thank you,

  From our team at Cognitive Performance & Healthxymogen