NeuroTap® Individual Intake Form
Thank you for registering your interest in NeuroTap® — the first New Zealand package that combines executive function assessment, personalised automations, and NFC tap-to-access tools.This short form will help us understand your needs and schedule your installation. It should take less than 3 minutes to complete.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Your NeuroTap® Setup
Organisation / Role
Where would you like the installation? (select all that apply)
*
Workplace
Home
Car
Other
What type of phone do you use?
*
iPhone (iOS)
Samsung (Android)
Other
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Next
Consent
I agree to be contacted by Studio Mindspace to arrange installation and follow-up support.
*
Yes
No
I understand my information will only be used for scheduling and service delivery, and will not be shared with third parties.
*
Yes
No
Once you submit this form, one of our consultants will be in touch to confirm next steps.
*
I understand
Please do not contact me
Submit
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