Sorry we presently do not accept ANY Insurance.

Information Starts Here:

1: Fill out the Enrollment request form below. If you select FAST TRACK, you will be sent an enrollment packet within 48hr.  

2: Once your Request is received we then send out Enrollment Packets every 2-3 days. Fast-Track within 48hrs to receive Enrollment Packet.

3: Once we receive your completed Enrollment Packet if you are Fast-Track you will be enrolled and labs ordered once your packet is reviewed and accepted. 

4: Those in states without a Millennium-TBI Network provider will need to locate someone to prescribe any medication.

5: As we build the Network of certified TBI providers you will be able to select from the list.  We are in need of more TBI-Network Physicians (link).

6: Due to the overwhelming number of applicants we are unable to specifically predict when you will be enrolled. Calling and asking will only delay it.

7: Also, due to the number of emails, questions, phone calls per week we are losing about 5 potential slots a week to enroll people. We request that you read the information we send you before calling.  

FYI: > What is included in the program (open).

FYI: > A letter of introduction to your physcian about our TBI Program.

FYI: > HIPPA RELEASE to share your case with your physician.

 

There is no fee to Enrollment in a Program or to fill-out a packet.  

 Selecting Fast-Track will get you reviewed for enrollment within 48 hours. 

Patient Enrollment Request

Incomplete  forms will be rejected by the system

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