Recorded NISE-Stim® Courses Request

NISE-Stim® Level 1, Level 2A and Level 2B Recorded Courses Request
Thank you for your interest in our NISE-Stim® recorded courses. Please complete the form below to request permission to have access to our recorded courses. If you have any questions, please email us at NISE@spinalstim.net.
NEXT STEPS:

1. NISE-Stim® will reveiw your submission and confirm you have the appropriate professional background. If you are requesting to take Level 2A and/or 2B we will confirm that you have previously taken Level 1.

2. Once approved, you will receive an email wtih a link to registrater for Level 1 or Level 2A and/or 2B. Levels 2A and 2B can be taken in any order.

Thank you,

NISE-Stim® team
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
City, State/Country in which you are licensed *
Qualifications *
If you selected "other medical professional" above, please tell us what your degree/training is in.
License number *
Level 1Level 2ALevel 2B
YesNo
If you have taken NISE-Stim Level 1, what date and location did you take NISE-Stim® Level 1?
I acknowledge that all course materials, presentations, videos, documents, and recordings related to NISE-Stim® are the intellectual property of Gerti Motavalli, LLC, protected by copyright law.I agree that I will not teach NISE-Stim® courses, workshops, or training sessions to other therapists or professionals, nor will I reproduce, distribute, or modify any NISE-Stim® materials for instructional, promotional, or commercial use.I may, however, educate families, caregivers, and other professionals about what NISE-Stim® is, its purpose, and its general benefits—provided such communication does not constitute teaching or training in the NISE-Stim® method.*
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NISE-Stim® Level 1, Level 2A and Level 2B Recorded Courses Request