Neurofeedback Equipment Order Form

Neurofeedback Equipment Order Form
Please complete all required fields to place your order for neurofeedback equipment. Ensure your contact and shipping information is accurate.
Full Name
First NameLast Name
Company or Organization Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Shipping Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Select Equipment to Order
prevnext( X )
Neurofeedback Amplifier Pro
High-precision 24-channel neurofeedback amplifier.
$3,500.00Quantity

EEG Cap (Adult)
Adjustable EEG cap for adult head sizes.
$250.00Quantity

EEG Cap (Child)
Adjustable EEG cap for child head sizes.
$230.00Quantity

Neurofeedback Software Suite
Comprehensive software for neurofeedback protocols.
$1,200.00Quantity

Sensor Gel Pack (100g)
Conductive gel for EEG sensors, 100g pack.
$20.00Quantity

Total
$0.00
Preferred Shipping Method
Purchase Order Number (if applicable)
Requested Delivery Date
MonthDayYear
Date
Order Notes or Special Instructions
Should be Empty: