Consent for Neurofeedback and Biofeedback Assessment or Treatment

Carl Laird Birmingham MD BSc MHSc FRCPC FACP ABIM FAED

Biofeedback and Neurofeedback is used for conditions that include ADD/ADHD, depression, anxiety, headaches, and addiction disorders. Neurofeedback is almost always one part of a number of therapies or changes that must occur in the patient’s life for the benefits of Neurofeedback to be lasting.

Neurofeedback is not covered under the BC Medical Insurance (MSP). The fee for Biofeedback and neurofeedback are not covered by BC Medical Insurance. Patients may be reimbursed if they have private health insurance. You are responsible for obtaining reimbursement from your plan.

How does Biofeedback and Neurofeedback feedback work?

1.  Brainwave activity and other measurements from the body like muscle tensing or skin temperature are measured.
2.  The measurements are fed back to the patients in a form they can understand, like sound, light, pictures or videos that can change in brightness or loudness, or activity, as the brainwave activity changes.
3.  The patient learns to adjust their brainwaves or muscle tensing or hand temperature as they change what they see or hear.

How is Biofeedback or Neurofeedback done?

Sensors are attached around the waist, to the fingers, the jaw, forehead or shoulders, the earlobes and the head to gather information. Nothing is done to the patient other than what would be done when an EKG (electrocardiogram) is recorded. The sensors simply measure changes in systems monitored. The information is seen on a computer screen and heard through speakers or headphones. The client is able to see and hear changes in their physiological activity and, by practicing self-regulation techniques such as relaxation and breathing, the client can learn to correct imbalances in the systems being monitored. This process may result in improvement in the client’s presenting condition(s) as these functional problems are corrected. Dr. Birmingham makes no claim or guarantee that biofeedback training will be effective for your specific concerns.

Patients have the right to complete and current information about any assessment by this practitioner and the recommend course of training, including how long it is expected to take. All client records and transactions are confidential unless release of these records is authorized in writing by the client, or otherwise required by law. Patients will have access to their records. Patients have the right to choose freely among available practitioners, and to change practitioners after services have begun. The client can expect a coordinated transfer if s/he changes service providers. Patients may refuse any service or training approach. Patients may freely assert any of these rights. Complaints about this practitioner may be made to College of Physicians and Surgeons of British Columbia. I have read and understood this document; I have had the opportunity to ask questions and have had those questions answered to my satisfaction. I have received a copy of this document for my records.

Signed: _______________________________________________________________________________ Date: ________________
Witness: ______________________________________________________________________________ Date: ________________

Download and Print the Consent Form