top of page

Consent Form

Adult Neurofeedback Training

White Text Transparent.png

Neurofeedback Training (NFT)

Neurofeedback Training (NFT) is a type of brain training based on learning through operant conditioning. Through the non-invasive and painless quantitative electroencephalogram (EEG) method, NFT measures and records your brain wave activity. The way that your brain training works is that when you are using your brain in ways that will help you with the behaviours that you wish to train in yourself (your personal, behavioural goals), you will be rewarded (positive feedback) with the continuation of a visual-audio stimulus of your choice that you will watch in our clinic's screen.

In contrast, when you use your brain in ways that hinder your behavioural goals, the visual-audio stimulus you are watching will begin to fade, pause and flicker (absence of reward of positive feedback). Therefore, through the experience that you gain from NFT, your brain ends up learning to function in the way that best enables the achievement of your behavioural goals.

This shaping of your behavioural goals is made possible by our clinic's experts, who personalize your training protocol for you in such a way that, whenever you train through NFT, you specifically train the brain areas and respective networks that are responsible for the behavioural goals of your choice.

Differently from the case of Psychotherapy, in which your behavioural goals are stated and the therapist works with you verbally to help you actively train such goals, in Neurofeedback Training (NFT), the behavioural goals that you've chosen to work on are targeted in terms of your brain so that you can train them directly and neurologically.

What NFT involves

NFT requires the placement of surface electrodes and conductive, neutral, water-based gel on your scalp, used to record your brain wave activity through EEG. The EEG signal is then used to provide you with the necessary feedback for your brain training in the form of visual-audio stimuli.

NFT Consultation

The NFT Consultation (the first NFT appointment that you will have) includes:

  1. A Psychology Intake Interview and a QEEG recording of your brain, and

  2. The Interpretation and Feedback by our Clinic's Neuroscience-Experts.

NFT treatment outcomes

NFT typically produces long-lasting positive neurological and behavioural effects. Visible positive changes in brain functioning are generally expected by the tenth NFT session.

While there are often neurological and behavioural improvements in the first few sessions, NFT usually requires at least 20 sessions, with a small number of subsequent follow-up reinforcement sessions (tapering), for long-lasting effects to occur.

Strengths and limitations of NFT

It is important to note that NFT is not designed and cannot be used to diagnose or investigate mental health or medical conditions. That way, regardless of the psychological or medical conditions that you might have, NFT is able to address the behavioural goals that you have for yourself by accessing and training those brain areas responsible for their optimal functioning.

Consequently, your brain is then rewired in those areas responsible for optimising your behavioural goals, such that those goals are improved in your life as much as possible. Sometimes, your symptoms may worsen before they improve, or your brain deviances may switch in a compensatory form from one brain area to another. This is a sign that your brain is learning (through training) quickly and that its positive changes will likely follow soon.

NFT precautions

NFT may change the dosage requirements for some medications. Therefore, it is essential that the physician monitoring your medication be made aware that you are using NFT. Do not stop or alter your medications without consulting with your physician. It is the client's responsibility to inform their GP or other health care provider and the NFT provider regarding changes in their symptoms or the development of new symptoms.

In addition, NFT can affect your glucose level as your brain works very hard when you train. Therefore, we ask you to please have a meal or snack before coming to appointments and let us know if you are diabetic or hypoglycaemic.

You must also let us know if you have ever had epileptic seizures.

Session Prerequisites

Hair: Please ensure that your hair is dry and free of any product at each visit to the clinic.

Towel: Following the EEG recording during your consultation and each NFT session thereafter, you will have a water-based gel on your scalp. Therefore, please bring a small towel with you on each visit to the clinic to rub off any excess gel when you are finished. We do not provide towels to clients.

Electronic devices and distractions: All mobile phones and devices must be switched off or put on aeroplane mode to avoid disturbing the clients’ sessions in the Dublin Mind Clinic.

Companion: Clients who are minors or need assistance can bring only one companion to  Dublin Mind Clinic therapy rooms.

Silence during sessions: The client and their companion are asked to remain silent throughout the NFT session to avoid distracting the client or disrupting their session.

Toilets: The NFT client will have a cap on with electrodes and gel on their scalp, which in turn are connected to an amplifier on the NFT provider’s computer. Therefore, NFT clients and their companions may only use the toilet before or after the NFT session (not during the NFT session) to avoid the disturbance of the NFT session and the disturbance of other sessions simultaneously taking place in the clinic.

Food and drinks: No food or drinks are allowed inside Dublin Mind Clinic therapy rooms, with the exception of a bottle of water that may be taken with you to your session.

Housekeeping

Please adhere to and respect our housekeeping rules listed below:

  1. No Photography

  2. No video recording / video calls

  3. No vehicles and animals inside the premises (except service animals)

  4. No property damaging

  5. No children are left unattended.

  6. Keep sound to a minimum to respect all sessions. Mute electronic devices and avoid calls while on the premise.

  7. Food and drinks: No food or beverages are allowed inside Dublin Mind Clinic therapy rooms, with the exception of a bottle of water that may be taken with you to your session.

  8. No disruption to ongoing sessions (i.e. knocking, door opening)

  9. All visitors must report to the reception.

Confidentiality

From the moment you get in touch with us, everything you say is confidential.

Our confidentiality policy is held for your own protection, and for the protection of vulnerable adults and children. Therefore, there will be no disclosure of your case or engagement.

The only limit to our confidentiality policy is when you or others are at risk of serious harm, life threat, safety threat, or criminal activity. This limit to our confidentiality policy includes but is not exclusive to reports of child-, elder-, and dependent adult- abuse, which can be physical-, sexual- or emotional- abuse; and expressed threats of violence.

As your Healthcare Representative, we are mandated people, i.e. we are legally obliged to report to Tusla (National child protection, early intervention and family support services Agency) any disclosure or concern of abuse or neglect, that is physical, sexual or emotional, and that occurs to anyone who is now under 18 years of age, or who was under 18 years of age at the time of the experienced abuse. Please note that, therefore, the limit to our confidentiality policy also includes retrospective reports of abuse, for example, if you are an adult now and you disclose having been abused as a child.

Note:

  • If you are in crisis, you can always text HELLO to 50808 or Call Samaritans using their freephone 116 123

  • Alternatively, if you have a risk emergency and need to reach us outside of hours, you may use our emergency phone contact and WhatsApp, 0899 72 42 30.

  • Please note that we are not an emergency service, such as hospitals, psychiatric units, Accident & Emergency (A&E), ambulances, police, fire brigade, or 24/7 services. Therefore, we can only help you within our scope of work availability and make relevant referrals for yourself.

Data Protection Policy

Dublin Mind Clinic collects and stores your personal information safely for the purpose of delivering the services provided by Dublin Mind Clinic to you as our client. In addition, your anonymous data is solely used for the purposes of research and development of our services.

Dublin Mind Clinic keeps your data due to legal requirements for seven years from the date you last engaged with our services, after which all of your data will be destroyed to protect your confidentiality further. In the case of clients who are minors, their data will be kept until they reach 24 years of age, after which point their data will also be destroyed.

Sessions

NFT sessions are typically arranged on a weekly basis and last up to 60 minutes. The recommended duration for NFT treatment is of 20 sessions, plus three tapering sessions thereafter - whilst considering a shorter or longer period, depending on the client’s needs.

NFT not only treats present symptoms, but also the origins of symptoms in light of preventing their future emergence. In addition, NFT enables the client to “train” and practice their personal skills and abilities to develop long-term coping strategies and resilience.
Therefore, NFT is based on a joint work between therapist and client, which in turn makes it crucial that the client commits fully to their treatment and that they are consistent in it.

It is not tolerated that sessions go overtime, as this jeopardizes the time-sensitive work that Dublin Mind Clinic commits to the development of its services for all of our clients. It is also not tolerated that clients block book their sessions in advance, as this jeopardizes other clients’ possibility to adhere to Dublin Mind Clinic’s weekly availability.

Fees

  1. Sessions must be paid in advance. You can pay your session fee via card at the reception before your session start or by paying the invoice in advance.

  2. You must first pay any outstanding session amounts before a next session can be booked.

  3. If you arrive at your session and are unable to pay any outstanding and/or current fees, it will be necessary to reschedule your session for a later date.

  4. Card payment: For card payments, please have your card ready for payment at reception before your session start. It is recommended to have a backup payment method in case the card is not accepted or if there are any technical issues.

  5. We do not accept cash or check payments.


Fees are not to be accumulated and paid at a later stage. Therefore, it is the client’s responsibility to ensure they have the required fee for their appointment.
​Dublin Mind Clinic fees are competitive and take into consideration individual clients’ financial needs. Therefore, each NFT Consultation is €200, and each NFT Weekly Session is €120.

 

Late Cancellations

Late cancellations within less than 48 hours in advance of the time of your upcoming session are charged half-price:

  • €60 for Neurofeedback Training (NFT) session

  • €100 for Neurofeedback Consultation

Otherwise, a minimum of 48 hours’ notice in advance of your appointment time is required in order to cancel your session free of charge.

 

No Show

If no effort is made to cancel your appointment 48 hours in advance of the time of your appointment, OR if you cancel your appointment within 2 hours or less from your appointment time, you will be charged in full for your missed session:

  • €120 for NFT Weekly Sessions

  • €200 for NFT Consultations


Otherwise, a minimum of 48 hours’ notice in advance of your appointment time is required in order to cancel your session free of charge.

 

 

Being late

If you are late for your appointment, we will do what we can to give you your full treatment time. However, treatment time may be shortened to allow us to finish on time for the next client.

 

First Appointment

You may call or e-mail Dublin Mind Clinic to make your first appointment. Although GP referrals are appreciated, they are not a requirement and you may make an appointment directly with us.

General Notes

Please note that we do not provide any advice regarding clients’ health insurances and taxes and clients’ eligibility to claim for their fees. It is the client’s responsibility to inform themselves with their health insurance about whether they are or not eligible to claim their fees.

Please be aware that Dublin Mind Clinic cannot answer to time-sensitive queries or concerns from clients that emerge between or outside of their sessions. Therefore, we ask that such time-sensitive queries or concerns are brought to your next session, where they can be addressed and planned.

Permission to be contacted

Please let us know if you give us permission to contact you between or outside of sessions where necessary or in your interest.

 

I hereby consent Dublin Mind Clinic to contact me via:

logo_dublin_mind_clinic_abr2020_final-10_edited.png
How do you identify yourself?

We require filling the consent form before booking an appointment.

To commence therapeutic services, we are legally required to collect certain information seen as 'sensitive protected data' under EU (GDPR) laws. For this, we kindly ask for your consent.


This process takes only ~10 min to complete but allows the therapist to study your case and in turn offer a more time-efficient experience for you.


Please note: this form is optimised for PC/Mac browsers. If you have difficulties completing it on your phone, we kindly ask you to try a browser on your PC/Mac.

Estimated completion time: 10min

Permission to contact other professionals
As a means to supporting you with our best service delivery, Dublin Mind Clinic may occasionally need to contact your GP or Psychiatrist to liaise with them to ensure the achievement and continuity of your best outcomes.

Therefore, please let us know if you give us permission to contact your:



 

Research and Training at Dublin Mind Clinic (Optional)

At Dublin Mind Clinic, we enable staff training and development in order to maximize our team’s professional excellence. In addition, we facilitate research projects to help maximize and update our empirical work further.

For the purposes of training, it may be that you might be asked for permission for one of our staff members to observe your session. For the purposes of research, it may be that you might be asked for permission for your stored data to be studied. Please bear in mind that, all stored data is anonymized so that it cannot be linked to any client from whom the data is collected. Therefore, stored data is never identifiable and client identity is confidentially protected at all times. Furthermore, any research studies which are carried out are firstly subject to full ethical approval from a trusted Academic Research Ethics Committee.

Please note that you are under no obligation to consent to this research and training section of our consent form. Your decision to take part in this section is voluntary and it will in no way affect the services provided to you at our clinic.
If you are happy to have one of our staff members observe some of your sessions, please tick the box below (optional).

If you are happy to have one of our staff members observe some of your sessions, please tick the box below (optional).

If you are happy for your confidential and anonymized stored data to be studied for research purposes, please tick the box below (optional).

Next of Kin Details

bottom of page