Consulting Engagement Form

Thanks for your interest in booking a Consulting Engagement with Dr. Shannon Bauman and the Concussion North team. To get the scheduling ball rolling, please complete the following Engagement Form and we will get back to you right away to finalize the details.

Name

First Name

Last Name

Email Address

What is the name of your company/organization?

What type of Consulting Engagement are you interested in? (Phone consult, Half-Day In-Clinic, Full-Day In-Clinic)?

Who will be participating in the Consulting Engagement?

What type of information and insight are you most interested in? What key questions do you have?

Is there anything else you'd like to share with us about what you'd like to get out of the Consulting Engagement with us?