Cognitive Health Assessment

Take a proactive step towards your health and support critical research and treatment in the process. $30 from every screening is donated to Alzheimer's Research Australia, and the assessment process is non for profit as rest of the cost covers the wages of the clinical team.

Clinical Enquiries - Clinical Advisory Group: cag@perthintegrated.com

When

Appointment by arrangement

Where

Brain and Cognitive Function Clinic
2 convenient locations

North
Unit 12, 8 Booth Place, Balcatta

South
Level 1, 48 Kishorn road, Applecross

Cost

Cognitive Health Assessment

$100.00

Your Details

First Name

Surname

Address 1

Address 2

Suburb

State

Postcode

Phone

Confirm Phone

Date of Birth

Are you aware of any family history of Alzheimer's or Dementia?

Yes No

Sibling

1st Generation - Parent, Aunt, Uncle, Cousin

2nd Generation - Grandparents, Great Aunt/Uncle

3rd Generation - Great Grandparents

Do you have a history or diagnosis of epilepsy, seizures or any photosensitivity?

Yes No

How did you hear about us?

PIHWaiver.pdf

I accept the terms in the attached waiver and acknowledge that my registration is non refundable.

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