Free Case Study Template 02
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CASE STUDY

BRAINMASTER CASE STUDY
CLINICIAN IDENTIFIER, CREDENTIALS, AND DATE OF SUBMISSION
(e.g. “G. L. Smith, Ph.D., BCIA-EEG 3/17/09”)
CASE IDENTIFIER1 (e.g. "abem1")
HISTORY / SYMPTOM HISTORY
(50 - 400 words)
PROCEDURE (TRAINING PROTOCOL, NUMBER OF SESSIONS, CHANGES)
(50 - 400 words)
RESULTS (CLINICAL AND REPORT FROM OTHERS)
(50 - 400 words)
PSYCHOMETRICS (pre- and post- neuropsych, IVA, TOVA, etc.)
BRIEF SUMMARY STATEMENT
(1 or 2 sentences)
ATTACHED GRAPHICS (insert graphics or list filenames (jpg, bmp, gif) below)
(pre- and post- QEEG, summary or trend graphs, etc)

I hereby submit this report as accurate to the best of my knowledge, and give permission
to BrainMaster Technologies, Inc. to report these results along with my identity.
Signed: _________________________________

Date: _____________________

Affiliation: ______________________________ Phone or Email: ________________
1

Case Identifier: Suggested use: use first three letters of last name followed by first letter of