For the best experience, please use a Google Chrome browser on a mobile device or computer; ensure your phone’s software is up to date, and have your insurance card available to upload.

Important Note: To ensure your information is saved securely, please do not refresh your browser or use the "back" button while completing this form. Navigating away from this page before clicking "SUBMIT" may result in the loss of your progress.

If you are having troubles, please STOP and contact our New Patient Intake Team at 615-224-9800, opt 1, or email newpatients@hopeforyourbrain.com.

Click "NEXT">  in the lower right section of the form to advance to the next slide.

It should take less than three (3) minutes. Click SUBMIT on the last page, and you will receive an email and text to schedule a call with a NEW PATIENT COORDINATOR to complete the process and answer any questions.

We are pleased to accept all major insurance plans and Medicare, and we will verify your coverage during the process.