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Monday - Sunday 7AM - 9PM+1 800 919 0118info@brainhealthusa.com14541 Delano StVan Nuys, CA 91411

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Name *

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Date of birth *//

Phone *

Insurance Name *

Social Security *

Do you take medication? *

Yes
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Previous Diagnosis? *

None
Depression
Anxiety
ADHD/ADD
Bipolar disorder
Schizophrenia
PTSD
Eating disorder
Insomnia
Autism
Substance abuse

Do you smoke weed? *

Yes
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Do you drink alcohol? *

Yes
No

Your medication will be delivered to your home within 24 hours from our partner pharmacy free of charge.

Fast Pill RX Pharmacy
7227 Van Nuys Blvd, Van Nuys, CA 91405
+1 (800) 525-1454

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Brain Health USA Center treats adults and children with depression, anxiety, ADHD, bipolar disorder, schizophrenia, autism, down syndrome, drug abuse, and PTSD.

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