NFL TBI Assessment Program:

    If you are an NFL Retiree and believe that you have sustained a Traumatic Brain Injury that has affected you, please read the following:

The Millennium Health Centers, Inc. has been providing leading edge hormonal assessment and treatment to Military, Civilian, and Sports individuals with a related traumatic brain injury (TBI).  Many of these patients experience significant improvement within 4-6 weeks of initiation of their treatment protocol(s). Many times the protocols include prescriptions of bio-identical hormones and supportive supplements. We are offering those NFL Retirees with TBI a free comprehensive laboratory assessment. This is not a 100% free program but the majority of the costs are in the testing which are waived. If you are interested in participating in this program, please fill out the form below. Once we receive your application (Intake Form) it will be reviewed for inclusion in this program. Someone from our offices will call you within 24 hours of submission of the intake form.

Thank you

Mark L. Gordon, M.D.  

NFL Intake Form                    Personal Information TBI

Active NFL?
First name:
Active?
Last name:
DoB:
 * required
Email:
 * required
Skype ID:
Telephone:
Mailing address:
Head Trauma History

NFC Region:

 Last 2 Teams:

 * required

Type of Injury:

Describe accident (Brief):

Symptoms:

Glasgow Score

Status:

Medical Care Received

Initial Care:

Subsequent Care:

Hospitalized:

Medication:

MedList1:

MedList2:

Other Issues:

Referral:

Name:

Legal Status:

If Active Litigation:

Travel Status:

 JANUARY 2014

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