Phone:
Phone/Fax:
Print Preview Print Clear
NEUROFEEDACK CONSENT FORM
Neurofeedback, also known as Neurotherapy, is a non-invasive treatment used to modify brain electrical activity (brain waves). It was found to be an effective treatment for symptoms of traumatic brain injury, mood disorders (depression and other), anxiety disorders, learning problems, ADD/ADHD, developmental disorders, stroke, seizure disorders, Tourette’s syndrome and other neuropsychological and neurological disorders and conditions.
The treatment is done by applying electrodes to the scalp, which feed information about brainwave activity to computerized EEG equipment. The information received by computer is then applied to specific neurofeedback protocols for training purposes.
The training consists of approximately 20-40 sessions (or more in some cases). Follow up visits from six months to a year may be suggested to monitor changes. There are rarely any side effects from Neurofeedback treatment; however, if any effects are noticed, we wish to be notified at once.
We are also interested in research, and data we collect is often included in our research studies. If data is used we protect the privacy of our patients by NOT giving any identifying information other than general demographic data.
I have read the above information and consent to Neurofeedback treatment.
Name: Date (MM/DD/YYYY):
Guardian:
I consent to having my data included in research studies.
Name: