Neurological Symptom Survey

Have you felt, or are you too young to be feeling “senior moments”. Where did I put the keys? Where did I park the car? What’s that person’s name? Perhaps you are feeling like your getting Alzheimer’s Parkinson, or dementia, and you are really scared.

Along with a thorough history, neurological exam, special lab tests, this survey will help you and Dr. Labbe, (or one of her highly trained licensed Mojo team doctor’s) guide you through the maze of what might be causing the forgetfulness, inability to find your words, or poor concentration. Find out if you have a tendency toward low seratone, Dopamine, gabba, insulin, progesterone, estrogen, or testosterone. Is this what may be contributing to your brain concerns?

Send this form with your intake forms (click here to download) prior to your consultation. If you are working with our office, please email us a copy of the completed form or fax it to 858-272-2677.

Click here to download a PDF to take to your healthcare provider!

Mojo Girlfriends Neurologic Survey