For assessment before you begin neurofeedback:
In order to plan your neurofeedback training so that you obtain the best possible outcome, we need to have information on your history, 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 for treatment. 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 about an hour to complete the survey. Each completed page is saved when you click on the “Next” button at the bottom. This allows you to stop the survey after completing any page and return to it at a later time. However, please be aware that you must use the same computer and cookie must be enabled. Be sure that you continue to click on the “Next” button at the bottom of the page until you have completed this survey. Then click on the final button to submit the survey.
For completion after each neurofeedback session:
Once you begin your neurofeedback training, we want to hear from you after every session about any changes you observed after the last neurofeedback session. Compare the time after the session to the day before. In the early stages of the training (first five sessions or so), please rate for the remainder of the day of the training session. After that, please compare the 24-48 hours after the session to the day before.
IF YOU HAVE OBSERVED NO CHANGE AT ALL, PLEASE LEAVE THAT ITEM BLANK.
Please be sure to complete this survey after every neurofeedback session. Having this information before you come in allows our team of professionals to discuss each session before you arrive for your visit and optimize the training parameters for your next session. You may want to bookmark this survey :
For completion only if requested:
When requested by Dr. Hirshberg, please complete one or more of these surveys: