Rental system request

Rental Request

The prices below include all equipment, supplies, and ongoing customer and technical support. Additionally, you can request an in-person demo session ($125 value for free the day you pick up the system). Unsure about which option to choose? Just fill out the form and we'll call you to discuss. No obligation!
Name *

First Name Last Name
E-mail *
Phone Number *

Area Code Phone Number
# of sessions in each month *

up to 10 sessions: $600/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/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) up to 100 sessions: $1,000/month or $10/session. Great for the whole family!
Minimum length of rental *

1 month 2 months (RECOMMENDED) 3 or more months Unsure (let's discuss on the phone)
How soon would you like the rental? *

Within a week Within a month
How would you like to receive the system? *

I will make an appointment to pick it up (In-office training and demonstration included in the rental package at NO extra cost to you - $125 value) I am not local, please ship it to me (shipping charges apply, phone training included)

Address *

NeurOptimal® renters agree to the following (review and check each item):

Have access to the internet and ensure the computerized system is updated and online at least once a week 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 but more importantly we want you to be satisfied with your progress) Fill out "Checklist of Concerns" forms https://www.beavertonneurofeedback.com/appointments before beginning brain training and after 10 sessions or 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 lease extension available upon request)
Any other questions or comments:
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Rental Request