• Biofeedback Consent Form

    Biofeedback Consent Form

  • I hereby authorize Essentia Center for Integrative Health, PLCC, to obtain a health history and perform biofeedback testing.

    Potential Risk

    Biofeedback testing and energy enhancement sessions are contraindicated during pregnancy and lactation, and in individuals wearing a pacemaker. It is very important for you to be forthright in informing Essentia of any disease process going on in your body, any prescription medications, over the counter, and illicit drugs. If you are pregnant or think that there is a potential to be pregnant, or if you are breastfeeding, or wearing a pacemaker, please advise the practitioner immediately.

    Although rare, there may be slight discomfort from a biofeedback session, including detoxification effects such as headaches, nausea, and flu-like symptoms, which usually resolve within 24 to 48 hours.

  • I hereby attest and agree to the following:*

  • I have read and understand the foregoing and agree to the terms and conditions set therein.

  • Format: (000) 000-0000.
  • Date Signed*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: