New Patient Sign-up Form

Use this form to register a patient for cognitive impairment therapy with one of our partner clinics. You will need your clinic's primary phone number to register.

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You have left off some important details that are not technically required, but you are encouraged to provide as much of this information as you have available.

  • Contact information (phone number or e-mail address at least)
  • Biological sex (assigned at birth)
  • Education level
  • Patient vitals (blood pressure, height and weight)

* denotes a required field.

E-mail support@umethod.com or call 984-232-6699, option #2 for assistance.

Return to the sign-in page