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To maintain confidentiality, the email above is where your suggestions will be emailed.

RESEARCH FOCUS: Here, specify the focus of the research requesting. If left blank, these factors may not be considered for the findings:

Hours (Select One):

• Work Hours:                   Distant Travel "To" Work Daily:
• College School Hours:      Distant Travel "To" College Daily:

Age:     Gender:      Weight:     Height:      Eye Color: 

Blood Pressure:   Blood Work (Results):

Known Food Allergies:     Known Medication Allergies:

Medications Intake (Dose/Frequency) Effect:

Supplement Intake (Dose/Frequency) Effect:

Medical History: 

Origin/Trigger of Brain Fog:

Last CT/MRI/PET Scan (State/Date/Results):

Personal Recreational Habits (Alcohol/Tobacco/Street Drugs/Frequency):

Food Consumption Preference: Vegetarian, Vegan, Semi-Vegetarian/Pescetarian, Omnivore (select one):  

Family Medical History:

Instructions: Type Your Explanations After Each Question. Do Not Remove the Text in the Textbox:

Case 1: Describe the Primary Activity that Warrants Strategic Thinking:

Case 2: Describe your engagement in the following processes: (a) Analytical Reasoning: (b) Following Instructions: (c) Creativity:

Case 3: List three (3) acts you believe that should be performed to think strategically: (a) (b) (c)

Symptom 1 ~ Pertaining to the Mind (Thinking/Emotions ~ Describe~Duration, Frequency):

Symptom 2 ~ Pertaining to the Head (Pain/Motor ~Describe~Location, Duration, Frequency):

Symptom 3 ~ Pertaining to the Head ~ Sensory (Eyes/Sight ~ Describe~Location, Movement, Duration, Frequency):

Symptom 4 ~ Pertaining to the Head (Mouth) ~ (Motor (Tongue) / Sensory (Speech) ~ Describe~Duration, Frequency):

Symptom 5 ~ Pertaining to the Head ~ Sensory (Hearing ~ Describe~Duration, Frequency):

Symptom 6 ~ Pertaining to the Neck (Motor/Pain ~ Describe~Location, Duration, Frequency):

Symptom 7 ~ Pertaining to the Spine ~ (Describe~Location, Duration, Frequency):

By pressing the submit button, I agree to the terms indicated on the Clearing the Mind to Think Strategically Research~Followup webpage (Brigette's Natural Healthcare Academia Research Firm~hereby known as the "Firm") and with the payment terms. I also certify that all the information presented in this submission is true, and I consent to the use of disclosure of the information submitted for healthcare research services. I acknowledge that the email address provided is secure, and that the Firm cannot and will not be held liable for any breach in the email system or of the information or misinformation transmitted using this electronic platform. I further understand the Firm cannot or will not be held legally liable for any symptoms (prior, current, future) to include symptoms that have been indicated or omitted in this transmission associated with the condition or disease of which is being researched. This Service Agreement and any dispute there under shall be governed by the laws of the State of Georgia, USA.