ACORN HEALTH ASSOCIATES, P.C.

4410 Linglestown Road Harrisb rg! "# 1711$ www.acornhealth.com 717-545-1938 voice 717-545-1948 %a&

Consent for EEG Biofeedback

'io%eedbac( is a )rocess b* which some as)ect o% *o r bod*+s % nctioning is meas red ,s ch as m scle tension! s(in tem)erat re! sweat gland activit*! or brainwaves-! and )resented to *o in a wa* it can be changed. .or e&am)le! *o might hear a tone and be as(ed to increase or decrease it. //0 'io%eedbac( involves )resenting in%ormation abo t *o r brainwaves so *o can change them in a wa* that will bene%it *o . 1o will normall* be as(ed to sit in an )right chair in %ront o% a com) ter screen. 2he )roced re involves )re)aration o% *o r scal) b* r bbing it with an alcohol s)onge! and a%%i&ing sensors! b* a non-abrasive adhesive. 3t is )ossible *o might e&)erience some redness at these sites. 2hese sensors )ic( ) signals %rom *o r scal). 4othing goes into *o r bod*. 2hen *o will be as(ed to watch a dis)la* on the com) ter and see i% *o can meet some goal. .or e&am)le! to ma(e a %rowning smile*-%ace smile! ma(e a dial t rn on a cloc(! or o)en the )etals o% a %lower. 1o ma* be given instr ctions to rela&! to engage in some imager*! or to sim)l* watch the dis)la* while listening to the so nds. 1o are %ree to end a session an*time *o wish -- 5 st signal *o r thera)ist who will remove *o r sensors %or *o . .rom start to %inish! sessions will last abo t 45 min tes. 6essions ma* be cond cted one to three or more times )er wee(! s all* var*ing between 1$ to 70 sessions! de)ending on the t*)e o% treatment. 3ndivid al cases ma* var*. 'io%eedbac( is sed to treat man* disorders. 3t teaches *o s(ill in reg lating *o r own bod* and brain. #ltho gh this is now generall* considered 8mainstream!9 some )s*chologists ma* not agree. 2his is )artic larl* so in the area o% brainwave bio%eedbac(. 2his is an e&citing area o% develo)ment in bio%eedbac(! and is changing ra)idl*. 6ome o% the )roced res have been s ))orted b* solid research st dies: others are based more on clinical e&)ertise and 5 dgment. #ltho gh it is being recommended to *o beca se *o r thera)ist believes it can hel) *o ! res lts cannot be g aranteed. 4ot all )s*chologists are a))ro)riatel* trained to se these )roced res. 3% *o have an* ; estions abo t the se o% bio%eedbac( %or *o r disorder! the )roced re itsel%! or the ; ali%ications o% the )erson administering the treatment! )lease as( %or clari%ication. "lease sign below that *o have read and nderstood this in%ormation! and that *o consent to *o r treatment. 2han( *o .

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