Contact us

I would love to hear from you. Please complete the contact form below and I will be in touch as soon as I am able.

If you wish to simply send me a message, please disregard the feedback questions on this form.
(NOTE: All client information submitted will be kept strictly confidential unless permission is given to use feedback on our website)

Name

Phone Number

Email Address

Diagnosis given prior to NIS treatment?

When problem started?

What problems, symptoms were you having?

Pain level prior to NIS treatment (0 = NO PAIN : 10 = SEVERE PAIN)

Pain level following NIS treatment (0 = NO PAIN : 10 = SEVERE PAIN)

Any changes after First treatment?

Any changes after Second treatment?

Any changes after Third treatment?

How did you find your experience with Optimal Neuro Health? How did you find your experience with Optimal Neuro Health? Exceeded my expectations Met my expectations Did not meet my expectations

Did your treatment at Optimal Neuro Health help your condition? Did your treatment at Optimal Neuro Health help your condition? Exceeded my expectations Met my expectations Did not meet my expectations

Would you recommend Optimal Neuro Health to others? Would you recommend Optimal Neuro Health to others? Yes No Maybe

Do you give permission for me to use your feedback on the Optimal Neuro Health website? Do you give permission for me to use your feedback on the Optimal Neuro Health website? Yes No Maybe

Any comments you would like to share about your experience with Optimal Neuro Health?

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Call: (027) 411 2670

What complaints may be helped by NIS?

STRUCTURAL – Spinal, Muscles,
Tendons, Ligaments, Joints

PHYSICAL – Immune, Digestive,
Respiratory, Heart, Chronic

PATHOLOGICAL – Infections,
Viral, Bacterial, Fungal, Protozoan

NEUROLOGICAL – Trauma, ADD / ADHD

HORMONAL – Depression, Fertility,
Female Health

EMOTIONAL – Anxiety, Bi Polar, PTSD

SLEEP PROBLEMS – Early Waking,
Initiating or Maintaining

Contact:

Optimal Neuro Health
Robyn Rusholme
13 Morpeth Street
Rapahoe
Greymouth 7803
New Zealand

Mobile: (027) 411 2670

Copyright:

Website Development by:

Kākatu Creative

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