RESTORE BEHAVIORAL HEALTH

NEUROFIELD NEUROTHERAPY INFORMED CONSENT:

I understand that Neurofield Neurotherapy is a new, experimental treatment modality combining Pulsed Electromagnetic Frequency (PEMF) therapy with transcranial neuromodulation therapies (TRNS, TPNS, TACS, TDCS) to help support the brain’s and body’s natural healing state for optimal functioning. I understand that while I may notice improvements in my functioning following the first session, Neurofield Neurotherapy works best when utilized in a series of sessions (e.g. 10-15 sessions) in order to reach my peak performance. I understand that I can stop the treatment at any time.

Possible side effects are mild and temporary and may include drowsiness and fatigue (especially if poor hydration and nutrition), a normal mild perception of flashing of light in visual field during the session, minor skin irritation under training site, shifts in energy/sleep patterns, minor headache or dizziness, mild nausea. If these occur at all, they will typically subside within 24-48 hours and can be reduced with modifications to your treatment plan.

I agree to maintain a Brain Healthy Lifestyle while undergoing this therapy in order to maintain adequate energy and well-being. This includes direct nutrition before and after the Neurofield sessions and a 15 min rest period following the treatment, as well as weekly exercise, removal of toxins from diet, maintaining a diet full of protein, healthy fats, vegetables, and fruits, minimizing stress, and keeping a regular sleep/wake schedule.

I understand that Neurofield Neurotherapy is intended to enhance well-being and therefore is not a replacement for psychotherapy and/or medication interventions for psychiatric disorders. Rather, neuromodulatory therapies offer a potentially useful adjunct to care. I agree to keep my prescribing physician informed of any side effects from medications that may develop during my neurotherapy treatment. and that I will likely benefit from combining this modality with psychotherapy if there are psychological stressors and/or trauma history that need processing.

I understand that Neurofield Neurotherapy is contraindicated if I am pregnant or planning to become pregnant; have metal implants or a shunt, a pacemaker or other implanted medical device; history of recent stroke, recent cancer diagnosis, active bleed, have a history of seizures; have skin lesions or scrapes near the site of stimulation; or an unstable medical condition.

I understand that Neurofield Neurotherapy has been utilized in thousands of sessions across many different countries with no significant deleterious effects and is considered safe for children and adults. Furthermore, multiple studies on PEMF, TDCS, and TACS attest to the safety and utility of these interventions.

I understand that Neurofield therapies are designed to help reduce stress and promote relaxation in the brain and body to allow for optimal natural healing and reorganization. I understand that the Neurofield therapies may be utilized on both brain and body to achieve an optimal state of healing and functionality.

Fee Schedule:

Neurofield Neurotherapy-30: $85.00

Neurofield Neurotherapy-45: $115.00

I understand and consent to the terms and conditions above and consent to receiving Neurofield Neurotherapy.