i • , Brain Resource t Center 263 West End Ave Suite #1D New York, NY 10023 April 9th 2014 Patient: We have charged you a deposit for I Please be advised that this charge is nonrefundable If you are okay with these conditions please sign your name below on the line. Thank You! Dr.Katnrun Fallahpour Brain Resource Center 1 EFTA_R1_02213325 EFTA02725776