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Home
|
Getting Started
Overview
Program Download
Trainer Orientation
Recommended Tests
Locate a Provider
FAQs
|
Our Approach
|
Programs
Overview
Description
Download
Pricing
Performance Guarantee
|
Outcome Studies
|
About Us
|
HIPAA
|
Contact Us
Professional Registration
IMPORTANT!!
Professional Registration is for New Professional Providers only.
If you are, or will be working with a Brain Power® Provider, you should not fill out this registration. Instead, have the Brain Power® Provider establish your User ID through their provider organization. If you are an independent Home User, you need to register from the Home User registration page.
Registration Date: 10/8/2024
Registration Information
*
User Name
*
Password
*
Verify Password
Organizational Information
*
Business/Provider Name
*
Address Line1
*
Organizational Model
Professional(i.e., Private Office)
Facility(i.e., Hospital, Clinic, Education Center)
Sole Proprietor(i.e.Private Clinic, Learning Cent)
Address Line2
*
Telephone
*
City, State
Business Web Site
*
Zip/Mail Code, Province
Country
United States
Antigua and Barbuda
Australia
Bahamas
Barbados
Belize
Botswana
Brunei
Cameroon
Canada
Dominica
Ethiopia
Fiji
Gambia
Ghana
Grenada
Guyana
India
Ireland
Israel
Jamaica
Kenya
Kiribati
Lesotho
Liberia
Malawi
Malta
Marshall Islands
Mauritius
Micronesia
Namibia
Nauru
New Zealand
Nigeria
Pakistan
Palau
Papua New Guinea
Philippines
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadin
Samoa
Seychelles
Sierra Leone
Singapore
Solomon Islands
South Africa
Swaziland
Tanzania
Tonga
Trinidad and Tobago
Tuvalu
Uganda
United Kingdom
Vanuatu
Zambia
Zimbabwe
Primary Contact
*
Email
*
First Name
Job Title
*
Last Name
Role
Administrator
Staff
Trainer
Billing contact is the same as the primary contact
Additional Information
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