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ONLINE COGMED TRAINING INTAKE FORM

(FOR ADULTS)

Please complete the preliminary eligibility intake form below.

Once your answers are reviewed, you will be emailed a response which indicates whether you are able to proceed to the next assessment stage.

STAGE ONE: PRELIMINARY ELIGIBILITY QUESTIONS

Please answer the following questions to help to determine the first stage of eligibility.

What is your gender?
If eligible, I would like to access this training program using:*
Do you have good, strong, unlimited internet access at your home?*
Does your computer have a well functioning mouse?
Can you easily manage a computer mouse?*
Training time could range from about 30 to 60 minutes, 3 to 5 days per week (depending on the chosen intervention). Up to an hour may be required to accommodate the training and any breaks. Can you set aside an hour per training day (could be 3 to 5 times a week, for up to 5 to 14 weeks)?*
The training environment needs to be a quiet, private room with a computer. Do you have the possibility to create a good training environment?*
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Thank you! Your responses were successfully sent. You will be emailed a response within a couple of days indicating whether you are able to proceed to the next assessment stage.
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