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 licensed clinical psychologist or medical doctor 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 attend a one day professional training hosted once per month in various locations. To view our upcoming training dates for future reference, click here.