new neurofeedback Client agreement

This form is the way you give permission to begin neurofeedback

I look forward to meeting you soon and beginning the journey of changing brain habits!

Name of person filling out form: *
Name of person filling out form:
The neurofeedback system used is the Brain-Trainer system for both mapping and neurofeedback sessions. Prices are $100 per brain map and $40 per training session. (Exceptions: $125 in-home/out of the area day rate & half-price single parent discount). *
The system is not a medical device and is not considered to be diagnosing or treating of any symptoms, illnesses, or diseases. There is ongoing scientific study showing that brain training offers benefits of changing brain habits. *
There is no guarantee for results or improvements, though the majority do find positive effects. For those with positive effects, sometimes the improvements fall off after the cessation of training. Periodic follow-up or booster sessions are recommended for these clients.
Neurofeedback training appears to be a harmless modality as far as is presently known. No injuries are known in the experience of the EEG Institute or reviewed literature. Nevertheless, there is not any representation promising the safety or efficacy of neurofeedback. *
Questions about how neurofeedback impacts your health should be addressed with medical providers. It is the client's responsibility to continue medications and therapies until otherwise advised by client's physician. It is also the client's responsibility to monitor the subjective effects of brain training and to continue only as long as perceived benefits are achieved. *
By submitting this form, client waives any claim of damages due to the training, including worsening of symptoms, claimed side effects, or failure to improve. Client agrees to take full responsibility for the benefits or lack of benefits of training and therefore holding harmless. *

Thank you! We are now ready to get mapping!