U.S.A. Patient Enrollment Request
We are experienceing a 1-2 week backlog. Please be patient while we arrange for your enrollment packet to be sent to you. Also, you might like to consider the Millennium Phase 2 protocol.
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*Referred by:	AVOID DELAY - SELECT ONE PLEASE PTSD Foundation Dr. Mark L. Gordon Dr. Alison Gordon Warrior Angels Foundation Quiet Explosion : The Movie Joe Rogan #1589 #1056 #700 WAKE Irreverent Warrior Heroic Hearts Foundation SOAA Grey Team Hunters 7 Veteran's in Pain Mike Mahler Bullet Proof - Dave Asprey A Millennium Patient My Healthcare Provider Read on Internet
*I am	AVOID DELAY - SELECT ONE PLEASE Returning Past Patient A Veteran SOV patient Active Duty Military Civilian with TBI Healthcare Provider with TBI Law Enforcement with TBI Fire Department with TBI Professional Athlete COVID Vax related Issues COVID Infection related Issues Long Covid Issues I never had a TBI Accutane - Not accepting new cases. PFS - Not accepting new cases. Bodybuilder needing help I am a Lawyer. I want HRT or TRT I have Psychiatric Issues NO TBI None of the above
Branch:	If Active/Veteran Select AIR FORCE ARMY MARINE NAVY COAST GUARD NATIONAL GUARD Air National Guard Special Forces G Other Military Now Law Enforcement
*My Case is	AVOID DELAY - SELECT ONE PLEASE Urgent Case Not Urgent Case Urgent Legal CASE Not Urgent Legal Case
Quiet Explosions	I have NOT seen the Documentary. I have seen the Documentary
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Gender:	Male Female
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DO NOT submit multiple requests they will ALL be deleted from this system. Incomplete request forms will be rejected. Verify that you have answered every line.