INFORMED CONSENT FORM( therapeutic assessment )

    Elumind Centres for Brain Excellence
    #210 – 221 West Esplanade Ave, North Vancouver (604) 220-8866
    INFORMED CONSENT FORM Our mission is to offer the most comprehensive array of services with the best-trained and most caring clinicians. This document contains important information and policies of Elumind Centres For Brain Excellence.
    Initial Therapeutic Assessment (The information below is also applicable to all consultations and sessions conducted via Telehealth) A Health Improvement Therapeutic Assessment will include a detailed review of your psychology, health history and your brain needs. Through the interview, we gather subjective data as to where the issues are arising from. Once the assessment is completed, the results may be consulted with other physician(s) within Elumind Centres For Brain Excellence to then offer you the service that would most benefit your healing needs. BRAIN HEALTH SERVICES QEEG Brain Map Elumind Centres provides the most advanced brain mapping in all of Canada. This QEEG (Quantitative Electroencephalography Mapping) is a comprehensive analysis of your brain’s current connectivity patterns allowing for a personalized brain health solution (neurostimulation, neurofeedback, TMS). What Makes Our Brain Mapping Unique? We have the most comprehensive brain mapping in Canada because we look at 55 brain areas. This provides an in-depth look into your brain’s pathways and areas of the brain which are not functioning at their optimal levels. After the brain map is complete, it is then analyzed and on a different day, the Director of Elumind will meet with you to explain in detail what areas of your brain need to be trained to achieve your optimal brain health. He will present you with a neurofeedback protocol (training plan) created specifically to you and your brain’s needs. Brain Mapping leaves out all guesswork in healing your brain! Neurofeedback Neurofeedback is a form of brain training that optimizes brain functions and treats a wide range of brain health conditions such as anxiety, depression, ADHD, autism. It is also used for performance-enhancing for athletes and business executives. Benefits And Risks Of Neurofeedback During the treatment session, the brain gets rewarded every time it engages in pathways that makes it resilient, calm, flexible and focused. Because the brain gets rewarded it repeatedly accesses those helpful pathways until they are permanently established. Generally, after the brain has learned a new pattern, the results should last. However, if you are confronted with an unexpected life challenge that affects the brain (i.e. trauma, loss of a loved one, extreme stress), you might need maintenance or “tune-up” sessions. Treatment results vary and are based on the weekly number of sessions and how much of your protocol you complete. The total number of sessions varies between individuals and is based on the brain map results or on the person’s severity of symptoms. Every brain is different and can have a faster or slower response to treatment. Neurofeedback is a non-invasive and painless training that is completely safe with no known long-term side effects. Any effects are usually transient and easily remedied if occur. Sometimes a person may notice a short-term change in symptoms as the brain adjusts to a new pattern. The symptom usually goes away on its own or can be minimized easily by the clinician’s adjustment of the treatment protocol. Also, another common experience may be transient vivid dreams or fatigue (neurofeedback is like going to the gym for the brain) after the first few sessions. We encourage you to report any discomfort during or after the session to the clinician/technician so that the treatment modality can be altered in your best interest. Please note that all equipment and preparations used during the delivery of Neurofeedback treatments at Elumind Centres For Brain Excellence are of the latest technology and their safety is guaranteed. Neurostimulation Neurostimulation is a system that provides a very low electrical current which changes the pattern of neuron activity. It has several clinical applications such as depression, anxiety, addiction and pain, to name a few. It can be a great adjunct to neurofeedback training as it enhances synaptic plasticity and thus amplifies brain training. Neurostimulation can prime the brain and give immediate noticeable benefit while neurofeedback training leads to long-lasting benefits. During neurostimulation most people feel mild tingling or warmth at the sites electrodes are placed, which are not painful and go away after stimulation stops. The currents used are safe and are not strong enough to even trigger an action potential in a neuron. It is a useful modality for pain relief. NeuroStimulation works by changing pain signals through electrical stimulation as well as through magnetic coils placed on the parts of the body that feel discomfort. This stimulation of cells causes capillaries to dilate, more blood to flow to that region, more oxygen is delivered to that area and allowing new healthy cells to be added where there is currently damage. Neurofeedback/NeuroStimulation And Medications While many people undergo brain training with the goal of reducing the need for medication and alleviating the symptoms, Neurofeedback/NeuroStimulation is not a substitute for the benefits of medication. Do not stop or alter your medications without consulting your physician. Also, be aware that brain training could affect your body’s response to other medications you are taking for conditions unrelated to the ones for which you are undergoing Neurofeedback. Should new symptoms appear to be developing, it is your responsibility to keep us informed of them as well as to inform your physician. We do not determine medication dosage, but we can be a resource to your referring physician, specialist, or mental health provider, and recommend this if your goals include a reduction in prescription medicines. Functional Medicine Functional Medicine is a holistic (whole mind/body) approach that helps restore health by addressing the underlying causes of dis-EASE. Our experts value your opinion in every step of the way moving away from the traditional disease-centred model to a patient-centered collaborative model of care. In this therapeutic relationship we observe all aspects of your life; nutrition, past and present medical and psychological history, occupation, habits and even physical living space. Functional medicine gets to the root cause of the problem eliminating band-aid approaches to chronic and complex health care problems thereby giving the power back to the patient. It uses evidence-based best medical practices integrating western (allopathic) medicine with integrative medicine. TMS Transcranial Magnetic Stimulation (TMS) is a non-invasive, painless treatment that directs recurring magnetic energy pulses at specific regions of the brain. This gentle procedure is used to treat many conditions including depression, anxiety disorders and post-traumatic stress disorder. Common side effects may include headache, scalp discomfort, or tingling/twitching of the facial muscles during the session. TMS requires a series of treatment sessions to be effective. Generally, sessions are carried out daily, five times a week for four to six weeks. Counselling And Life Coaching Counselling and life coaching are confidential processes designed to help you address your concerns, come to a greater understanding of yourself, and learn effective personal and interpersonal coping strategies. They involve a relationship between you and a trained therapist who has the desire and willingness to help you accomplish your individual goals. Sharing of sensitive, personal, and private information is involved. Some of the benefits may include gaining personal insight, learning new ways to cope and overcoming/changing behaviours that are causing you difficulty or pain in your life. Some of the risks of counselling/life coaching may include evoking strong emotions or difficult memories. The therapist/life coach relationship is a professional relationship. Social and business relations between the therapist and a client are discouraged by professional codes of ethics. This applies during sessions and outside of sessions and continues after sessions end. Confidentiality All interactions with our staff, including scheduling of or attendance at appointments, the content of your sessions, progress and your records are strictly confidential. No record is contained in any academic, educational, or job placement file. Both by law and our professional standards require that we keep appropriate records. In general, the confidentially of all communication between you and Elumind is protected by law, and we can only release information about your progress to others with your written consent. However, provincial laws and professional codes of ethics limit confidentiality in the following circumstances:
    • If there is evidence of the clear and imminent danger of harm to self and/or others, Elumind is legally required to report this information to the authorities responsible for ensuring safety.
    • If you disclose information that indicates a child [under the age of 19] or a vulnerable adult is at risk for neglect, physical or sexual abuse, Elumind is required by law to report to the Ministry for Children and Families
    • Elumind is subpoenaed as a witness in court
    • A court order, issued by a judge, may require the Elumind staff to release information contained in records and/or require Elumind to testify in a court hearing.
    Cancellation policy We appreciate prompt presence for Telehealth (online) sessions or in-person arrival for appointments. Please notify us by call or text at (604) 220-8866 if you will be late. A minimum of 24 hour business day (Monday-Friday) notice of cancellation is required as it allows us to use the time for others. We are closed on weekends and do not take cancellations. Should there be a NO SHOW or less than 24 hour business day operation cancellation: - For Counselling/Life coaching: full session fee will be charged - For Neurofeedback/Neurostimulation/TMS: a single session will be charged - For Therapeutic Assessment (TA): $125 will be charged Thank you for your understanding Insurance We do not directly process insurance, but you may decide to independently pursue reimbursement. Upon completion of sessions, we will provide you with an electronic receipt. Signature of Client OR if Client is Under 18, Signature of Parent/Guardian
    COVID-19: Our centre follows the BC College of Physicians and BC Ministry of Health infection control and disease management guidelines. Furthermore, we adhere to the highest standards of employee safety as per Work Safe BC to ensure that our staff are protected, which in turn translates to you being safe when going through your therapeutic experience with Elumind Centres. For more details check out our website.