Preliminary Licensee Information Form

Thank you for your interest in becoming qualified to provide Cogmed in your practice/institution. Please fill out the form below and a Cogmed representative will follow up with you shortly to discuss things further.

Note that Cogmed works with a specific profile and requires each practice/institution to have a qualified healthcare professional that serves as the head of the administration of Cogmed for that practice. Each application is reviewed before the Cogmed license agreement is sent.

Keep in mind that in order to start providing the Cogmed program, you will first need to go through our professional training. The training is done via an online, self-guided platform that you do on your own time.