CCSVI Testing and CCSVI Treatment Scheduling

San Diego, CA (typically 2-4 day stay)

Please Download and Print Required Forms, CLICK HERE. This download contains:

1. Referral Request Form- to be completed by patient's physician (neuro, GP, acupuncturist etc.). Referrals from MDs outside the US accepted.


2. Patient Contact Form- to be completed by patient or patient's representative.

Upon completion of required forms, please send both TOGETHER by 

Fax To: (858) 444-3599

Or, Mail To: Applied fMRI Institute 10065 Old Grove Rd. Suite 103, San Diego, CA 92131 and include your full name and contact information.

If you have questions regarding billing for the test and the treatment, please email HubbardFoundation@gmail.com

http://www.hubbardfoundation.org/CCSVI_scheduling.html