Please read the following:
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Below is the Patient Intake form.
It will be used to determine how best to utilize our resources. Not every potential patient will be a candidate for our practice since legally, it will be mandatory for you to come to our offices in Encino California in order to actually start any treatments. We can have a nurse draw your blood in your home or office which is sent to our laboratory for testing.  If you are unable to come to our offices we can provide your physician with a copy of your comprehensive report that includes treatment recommendations. We are in the process of training select physicians in our TBI protocols so that we can provide a certified physicians in each state to provide the level of assessment and treatment that is necessary for optimal improve from the symptoms associated with Mild-Traumatic Brain Injury.  These physicians will be listed on this site in the future. Thank you. Mark L. Gordon, M.D. 

   We have received over 150 Intake forms in the past 4days since this article appeared in Life Extension Magazine. We are only one office, at this time, with over 15 years of experience using hormonal replacement protocols as a means of improving the consequences of Traumatic Brain Injury. In the past we have limited our practice to those people that can come into the office for an appropriate work up based upon a specific group of hormonal tests. Many of you cannot come to the office due to handicap or distance. We do offer the ability to perform remote laboratory testing but, we will not be able to treat you unless you are in our offices.  We do provide a comprehensive report that includes recommendations for treatment.  This "Patient/Physician Handbook" can be given to your personal physician as a guide to your treatment.   Thank you.

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Patient Intake Form         Personal Information TBI

First name:
Last name:
Date of Birth (18-60yrs):
 * required
Email:
 * required
Telephone:
Mailing address:
Head Trauma History

Number of TBI:

Date(s) of TBI(s):

Type of Injury:

Describe accident (Brief):
   
   

Symptoms:

Glasgow Score

Status:

Medical Care Received

Initial Care:

Subsequent Care:

Hospitalized:

Medication:

Other Issues:

Legal Status:

Travel Status: