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NEX Pathway
Referral Form

Precision Brain Health | Physician Led Assessment
Phone: 587-486-2269 | Fax: 587-479-0948 | Web: www.nexcerebrum.com | Mail: info@nexcerebrum.com
Referral for individuals aged 40+ with early memory, cognitive or functional concerns. Includes evaluation at all stages of suspected dementia.
Patient Information
Referring Provider (if applicable)
Reason for Referral (check all that apply)
Requested Pathway *
For individuals without a confirmed dementia diagnosis seeking a detailed cognitive and biological assessment under physician supervision. Includes advanced blood-based biomarkers (including pTau217 and APOE genotyping), extended cognitive assessment, MRI brain volumetrics, physician interpretation, and individualized clinical recommendations.
For individuals with an existing diagnosis of dementia or cognitive disorder seeking additional biological information to support diagnostic clarification. No MRI included. Biomarker results are reviewed in the context of the patient's existing clinical diagnosis.
No MRI included. Biomarker results are reviewed in the context of the patient’s existing clinical diagnosis.
Clinical Notes
Patient Acknowledgement
Email: info@nexcerebrum.com | NEX Pathway referrals: Cortico eReferral – Dr. Dilpriya Mangat (Geriatric Medicine)
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