CONFIDENTIAL 

Completing this form does not commit you to participate in the  Behavioral Response Evaluation© program. The purpose for the information is to ascertain if the equipment makes sense for the practice based on patient metrics.

BRE PAS has never had a participating healthcare facility failure using our BRE© testing system. In order to protect that statistic, it is important that we gather the following information in advance of potential participation to determine eligibility. Thank you in advance for your time spent completing this form as accurately as possible.

A representative from BRE PAS will be in contact with you to go over your information with you.

Click on the PDF to download the form.

Email back to inquire@bresystem.com

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