Biofeedback Form – Be Naturally Well

Be Naturally Well PMA

Biofeedback and Wellness Services

BIOFEEDBACK INTAKE FORM AND AGREEMENT

NaturallyWell Inc. and Christine Knapp-Phillips, RN, MSN, FNP, CBT are focused on supporting your health and well-being naturally. As a Biofeedback Technician, and Family Nurse Practitioner, my goal is to focus on non-drug therapies to complement your health. NaturallyWell Inc. seeks to employ evidence-based techniques and realizes that not everyone agrees with the evidence. Both validation and verification are important. Client/Patient safety is my primary concern. Natural process, awareness, drugless, and safe subtle energetic therapies are the skillful interventions utilized to help you. The goal is to help you increase your awareness of your body’s stress while decreasing your stress and stressor levels. Lifestyle and symptom questions are pertinent to understanding your current state of health and provide for awareness as well as increase insight into your health as to the causative stress factors. Information from sessions will be shared with your health care provider(s) when requested and with written consent. By signing this agreement, I acknowledge that NaturallyWell Inc. will not be diagnosing any disease and agree that diagnosing is not needed to perform Biofeedback training.

BIOFEEDBACK

Biofeedback is a complementary and alternative medicine technique which enables an individual to learn to change some physiological activities for improving health. Biofeedback measures and receives information (feedback) about the body (bio). The biofeedback sensors use mild electrical impulses that measure skin temperature known as Electro Dermal Response (EDR), which teaches the individual to make subtle bodily changes, such as relaxing certain muscles to achieve desired results, such as reducing pain. Biofeedback is often used as a relaxation technique. Remote sessions are also available as needed.

The instrument utilized in the training session is called the EDUCTOR biofeedback system, which requires that the client connect to the system with pads/straps to measure EDR, Electro Dermal Response. The scope of my practice using this biofeedback system includes stress reduction training programs for relaxation training, pain management, muscle re-education and brainwave training. Biofeedback training is a complement, not a substitute for medical or psychological treatment, and is not intended to replace any ongoing treatments by your health care provider per USA FDA guidelines.

CONFIDENTIALITY

Client information will be kept in confidence and will not be disclosed to anyone outside of NaturallyWell Inc. without your consent.

Biofeedback

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