brain-training informed consent Dena McComb Trauma-Informed Coach, Integrative Health Coach, Yoga Instructor & Brain-Trainer First Name *Last Name *Email Address *I agree to receive emails from Dena McCombInformed Consent This Agreement is intended to provide the client listed above with important information regarding the practices, policies, and procedures of Dena McComb. Any questions and concerns regarding the contents of this Agreement should be discussed with Dena McComb prior to signing it. Dena McComb offers Brainwave Training (also known as Neurofeedback) in connection with a variety of conditions that appear to be associated with dysregulation of brain activity, including hyperactivity and attention deficits, reactive attachment disorder, behavior problems, sleep disorders, depression, anxiety, chronic pain, and other conditions. Dena McComb is not a physician and does not treat or diagnose symptoms, illnesses or diseases. Dena is aware, by experience, training and through the literature, of beneficial effects of the kind of brain training offered. Scientific investigation is ongoing to determine the mechanism by which these benefits are achieved. At present, Dena McComb agrees with the EEG Institute who recommends the training on the basis of empirical observations of improvement in clients with similar conditions. No guarantee is made that any individual client will improve with training. It is possible that some clients who do experience benefit, the improvement may fall off after the cessation of training. Those individuals would benefit from periodic follow-up or booster sessions. The training appears to be a harmless procedure as far as is known at present. No injuries are known in the experience of EEG Institute, or in the literature reviewed. Brainwave Training is a non-invasive procedure. Nevertheless, beyond this, Dena McComb does not make any representation concerning the efficacy of training. Any questions should be addressed to the prospective client’s physician. The client should continue ongoing therapies and medications until otherwise advised by a physician. It is the client’s responsibility to monitor the subjective effects of Brainwave training and to continue training so long as benefit is perceived. By signing this form, the client indicates his/her understanding of the principles set forth here, and waives any claim of damages due to brainwave training, including worsening of the client’s condition for which the training was undertaken, claimed side effects, or the failure to improve with training. In addition, the client agrees to take full responsibility for his/her training, the benefit of such training, or the lack thereof, and further agrees to hold Dena McComb harmless from all claims associated with such training. If there is a need to speak directly with your primary care practitioner, or if we need further information (reports, tests, etc.), we will request that you sign a release of information allowing us to have that communication.Please check the box if you agree to the following (optional):I agree to being photographed and allow my photo, video or filmlikeness to be used for training and/or promotional purposes by Dena McComb.I hereby certify that I have read this document; I understand its content and agree to the terms above.I am aware that this is a release of liability as well as a contract and I sign it of my own free will.Type your Full Name (First and Last) *Date *SUBMIT