Home Equipment Reservation Request
A minimum length of use is 30 days. Call (971) 238-8092 for questions.
Name
*
First Name
Last Name
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Who/how many people will be using the home equipment?
*
Select your monthly package (if in doubt, you may select the smaller package as you will have an option to upgrade at any time)
*
up to 10 sessions: $600 per month or $60/session. Ideal for 1 person to train 2-3 times/week ($25 for each additional session if more needed)
up to 20 sessions: $800 per month or $40/session. Intensive training for 1 person or to be shared between 2 family members ($25 for each additional session if more needed)
unlimited sessions: $1,000 per month (Can be shared with family members)
Length of rental (the minimum term is 30 days)
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1 month
2 months
Other
When would you like the rental? This can be approximate (unless we already set a date), only needed to manage incoming requests)
*
As soon as the system is available!
Other
Address
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Secondary Contact (the person I can contact if you go MIA)
*
First Name
Last Name
Relationship to you
*
Phone Number
*
-
Area Code
Phone Number
NeurOptimal® renters agree to the following (review and check each item):
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Communicate regularly with the Beaverton Neurofeedback representative throughout your rental period, ask questions, and update us on your progress
Treat the equipment with care
Set a training schedule to use the equipment regularly for maximum usage and benefit (no refund is given for unused sessions)
Fill out "Checklist of Concerns" form for every person using the equipment https://www.beavertonneurofeedback.com/client-forms before beginning brain training and at the conclusion of the rental term
Understand that NeurOptimal® is a type of brain training (designated by the FDA as a wellness device), it is NOT medical treatment
Return the system on or before the date indicated in the lease agreement ($50/day add-on extension available upon request)
Any questions, comments, special requests?
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