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Healthy Brain Research Study

Accepting California Residents Only

Interested in learning more about your brain? Participate in our Healthy Brain Study! Participants receive two SPECT scans, a complete brain evaluation, and $250. Take our brief questionnaire to see if you qualify.

The study is being conducted at the Amen Clinic in Newport Beach, CA. Participants are required to travel to Newport Beach, CA at their own expense and arrange for their own lodging during the course of the study.

First Name:
Last Name:
Gender:	Male Female
Age:
Email Address:
Phone Number:	(optional)
State:

Please select either a yes or no answer for each question below. All questions must be answered to be considered for the study.

yes	no	Have you ever been diagnosed with ADD/ADHD or any other psychiatric/ psychological disorder?

yes	no	Do you have any parents, children, or siblings who have ever been diagnosed with ADD/ADHD or any other psychiatric/psychological disorder?

yes	no	Do you use drugs or alcohol excessively?

yes	no	Do you have any parents, children, or siblings who use drugs or alcohol excessively?

yes	no	Do you have any serious problems with your memory?

yes	no	Do you have any parents, children, or siblings who have dementia or serious memory problems?

yes	no	Do you have any parents, children, or siblings who are mentally retarded?

yes	no	Have you ever been diagnosed with a neurological disorder, such as epilepsy?

yes	no	Do you have any chronic health problems?

yes	no	Have you ever had a serious head injury (where you were knocked dizzy or unconscious)?

If you have any questions or would like to set up a consultation with an
Amen Clinic doctor please call the clinic nearest you. We can help with:

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Medical Disclaimer: The information on this web site is for general informational purposes only. It is not a substitute for a medical evaluation. If you feel that medical interventions are necessary, please check with your physician.

Information and resources for patients and prospective patients.

Information and research on brain SPECT imaging.

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