Neurokinex ARC-EX Registry Form

Neurokinex ARC-EX Registry
Neurokinex centres will be providing ARC-EX therapy from early 2026.

In order to register your interest and be kept up to date of developments associated with ARC-EX powered programmes at Neurokinex, please complete the form below.
Name*
Email Address*
example@example.com
Phone Number*
Date of Birth*

DayMonthYear
Date
Describe your injury or condition*
Please confirm whether you are in the United Kingdom:*

YesNo
Do you have any implanted devices (eg pacemaker, pump):*

YesNo
If yes, please describe your implanted device(s)
Preferred Neurokinex Centre*
By submitting this form, I consent to being contacted by the Neurokinex Team relating to ARC-EX therapy.
Should be Empty: