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All information submitted through our online reports is encrypted through SSL encryption. SSL is short for Secure Sockets Layer. SSL is a protocol developed to securely transmit private documents or information via the Internet. It works through a cryptographic system that secures a connection between a client and a server. Information secured in this way meets standards for protection of Healthcare Information as specified in HIPAA.
However, please be aware that we cannot GUARANTEE your privacy using these online surveys. If you prefer, you may complete any of these online forms on paper and either mail or fax them to us for security purposes. By completing this form on-line and submitting it upon completion, you are acknowledging and accepting the risk that this information may not be secure.
For surveys to be completed as part of the initial assessment before neurofeedback begins, click here.
For the checklist to be completed after every neurofeedback session, click here.
BEFORE NEUROFEEDBACK BEGINS
FOR EVERYONE
In order to plan your neurofeedback training so that you obtain the best possible outome, we need to have information on your symptoms, patterns of functioning, strengths and weaknesses, and your goals for the training. We have designed a survey for you to complete online to provide us with this information as efficiently as possible. We also ask that you read and provide your agreement in two documents - our agreement on treatment outcomes and an informed consent. These are included in the survey.
There are two versions of this survey: One to be completed by parents when a child or adolescent is getting neurofeedback, and one to be completed by adults when they are getting neurofeedback. Once you are finished with the survey, you will be redirected to a webform that will notify us that you are done. We will then contact you to schedule your qEEG.
It should take you approximately 60 minutes to complete the survey. Please be sure to give yourself enough time to complete it.
To begin, please click below to complete the survey either for adult neurofeedback patients or for child and adolescent neurofeedback patients.
THESE SURVEYS SHOULD BE COMPLETED ONLY FOR PATIENTS WHO ARE PLANNING TO BEGIN NEUROFEEDBACK!
Survey for adult neurofeedback patients
Survey for child and adolescent neurofeedback patients
ONLY IF REQUESTED:
Below are surveys you may be asked to complete as part of your iniital assessment for neurofeedback:
PTSD Checklist for Veterans (PCL-M).
AFTER NEUROFEEDBACK SESSIONS
FOR EVERYONE:
The surveys below are done throughout the period when neurofeedback training is being done.
Checklist of changes after each neurofeedback session. Please complete this survey after every neurofeedback session. Please use the same form for home and office based training. Since you will complete this report after every session, you may want to bookmark this site for convenience.
ONLY IF REQUESTED:
Below are surveys you may be asked to complete throughout the period when neurofeedback is done:
PTSD Checklist Past Week (PCL-C) . Please complete this survey after each two neurofeedback sessions only if requested.
PTSD Checklist Past Week for Veterans (PCL-M). Please complete this survey after each two neurofeedback sessions if you are a Veteran with combat related trauma.
PANAS Please complete this survey after each two neurofeedback sessions only if requested