New Client Neurofeedback Form

Welcome to
Neurofeedback Solutions Forms Page

These are our intake forms.   Please bring them with you to the first session.  If you have questions by something on a form, just skip that question and we can figure it out together when you get here. Thank you.

For All New Neurofeedback Clients:

Click here to complete the New Client Intake Form.

Click here to complete Medical/Psychiatric History Form.

Click here to complete Neurofeedback Consent Form. Complete one form for each person receiving neurofeedback.

For Consulting with Other People or Professionals:

By completing this Release of Information Form you will be allowing The Neurofeedback Solutions Clinicians, Ce Eshelman, LMFT, Jen Nguyen, LMFT, and Alcira Ascencio, LMFT to contact other people or professionals for the purpose of continuity of care.