Pre-Enroll in FastBraiin's Extended Care Program

For qualifying patients, FastBraiin provides a free, extended care program for families with mental health concerns. Our program offers you the support, care, and assistance you need to successfully navigate the challenges of parenting ADHD/FastBraiin children.

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Phone

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* 5. How old is your child?

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* 6. What is the most pressing issue with your child?

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* 7. How concerned are you for your child?

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* 8. How much are you struggling as a parent?

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* 9. How did you hear about FastBraiin?

Thank you for filling out our enrollment form. We will be in touch with you soon!

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