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Welcome to Brain Health Counseling and Neurofeedback, Inc.  We are excited to meet you and walk side by side with you on your healing journey.

Please fill out the paperwork below and bring to your first appointment. You will need three forms  1) intake form 2) credit/debit form 3) consent form.

Choose the consent form based on what your appointment is for. If you are unsure of what type of Neurofeedback services are suggested for your condition, please consult with the office to find out beforehand. You may also complete all three Neurofeedback consent forms if you are interested in trying all of them.

Please call the office: 916-862-5207 for any questions you may have about this process.

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Intake Form

This form provides us with all the necessary information for you to get started as a patient. Included is the HIPPAA privacy policy notice which explains how your electronic information may be used.

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Adult Informed Consent Form

This is the consent to mental health treatment for adults 18 or older as well as our policies and procedures.  Please read through from beginning to end as it covers important information.

Credit/Debit Card Agreement Form

We have a firm cancellation policy which is outlined in the informed consent. The credit/debit card must be kept on file in the instance you do not provide at least 24 hours notice to cancel  your appointment.

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LENS Neurofeedback Informed Consent

This form provides us with all the necessary information about the Low Energy Neurofeedback System (LENS)

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Z3 Neurofeedback Consent

The Z3 combines Transcranial Direct Current (tDCS), Alternating Current (tACS), and Random Noise (tRNS) stimulation into one unit. This is the information and consent form to learn more and to get started. 

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Neurofield Neurofeedback Consent Form

This is the consent for our Neurofield Neurofeedback system

Questions? Call Us: 916-862-5207

Office Hours

Monday-Friday
9am -5pm

 

 

Please leave a voicemail if you are unable to reach us and we will get

back to you as soon as possible, thank you!