- NorCal Neurofeedback · Upper left image courtesy of NeuroFitness Wellness Center-Southfield, MI...

; Wellness Enhancement; Stress Reduction; Ease Return of Veterans into Home & Work Life; Academia & Work Performance; Athletic & Sports Training; As Part of an Anti-Aging Program; Enhance Creativity & Awareness; Personal & Spiritual Development in Individual

& Group Settings; Enrich Couple, Family & Work Relationships; Groups Running in Retreat Settings; Preparation for Testing: Improved Focus,

Attention & Retention, Ease Test Anxiety

NeurOptimal® can help:

WWW.NEUROPTIMAL.COM

THE new NEUROFEEDBACK

Developed by Clinical Psychologists, NeurOptimal®

is the world’s first & only Dynamical Neurofeedback™ brain training system.

Working directly with the central nervous system can:help improve cognitive functions • enhance focus • deepen sleep • increase physical performance

With 17 years and over 3 MILLION hours of use worldwide, NeurOptimal® is an advanced, time-tested, safe and effective neurofeedback system.

You CAN get the most out of life! Find your next level with NeurOptimal®.

“After almost 23 years of being “hostage” to psychotropic (anti-depressants) drugs, I am, as of July 2008 completely drug free!” - M.W., Fairfax, VA

INSERT REP CONTACT HERE

www.neuroptimal.com

I understand that NeurOptimal® is not a medical treatment, device or methodology. It is not used to diagnose medical disorders nor is it used as a medical treatment for disorders and has not been approved for any medical purpose by the FDA, Health Canada or any other governing agency. While Zengar users may or may not be licensed health care practitioners, their use of NeurOptimal® is solely as a tool for brain training and optimization and not as a means of diagnosis or as a medical intervention.

I am satisfied with the information I have been provided (verbal, written or otherwise) by my trainer on the effects I can expect during my NeurOptimal® training and my questions have been answered to my satisfaction. I understand that it is not possible to predict what my central nervous system will do with the information it is offered and consequently there can be no guarantee as to the results of my training.

I agree to cease training if I am less than happy with the results I am getting. I understand NeurOptimal® is purely a source of information and does not direct the response of the central nervous system. Consequently I agree to not hold Zengar Institute Inc or any of its users and trainers responsible for a less than desired outcome or any outcome that may be considered negative.

Your Signature Today’s Date

Your Printed Name

CLIENT INFORMED CONSENT

¹ dba NorCal Neurofeedback, 4120 Cameron Park Dr., Ste. 205, Cameron Park, CA 95682 tel./text: (530) 350-0169 email: [email protected]

NeurOptimal® Neurofeedback Training Craig Walker, Certified Advanced NeurOptimal® Trainer¹ by the Zengar Institute

Clients typically find NeurOptimal® neurofeedback effective in resolving issues in five general categories:

►Wellness and personal growth ►Slowing the effects of Brain Aging ►Achieving an Artistic or Athletic Performance Edge ►Enhancing Academic Performance (e.g., focus and attention) ►Help with Specific Cognitive, Emotional, or Physical Challenges (e.g., ADHD, anxiety, chronic pain, migraine, sleep, PTSD, depression, addiction, ChemoBrain, autonomic and central nervous system imbalance)

Note: NeurOptimal® is not a medical device and its intended use is for brain training and optimization

For general information please visit — http://www.norcalneurofeedback.com/

NeurOptimal® Explainer Video — http://bit.ly/NeurOptimalExplained

NeurOptimal® Neurofeedback and Sleep courtesy of BrainSpa Neurofeedback— http://bit.ly/NeurOptimalSleep

ADD/ADHD and Youth Focus courtesy of InnerOptimal — http://bit.ly/NeurOptimalADD-ADHD

Child Night Terrors/Nightmares courtesy of NeurOptimal — http://bit.ly/NeurOptimalNightTerrors

Military Veteran Stress and PTSD courtesy of InnerOptimal — http://bit.ly/NeurOptimalPTSD

Sports Concussion courtesy of CBS Denver 4 — http://bit.ly/NeurofeedbackConcussion

Neurofeedback and Addiction courtesy of DoctorClarity — http://bit.ly/NeurofeedbackAddiction

ChemoBrain courtesy of Lake Erie Brain Performance Institute — http://bit.ly/NeurOptimalChemoBrain

Cancer courtesy of NeurOptimal® — http://bit.ly/NeurOptimalCancer

Aphasia courtesy of NeurOptimal® — http://bit.ly/NeurOptimalAphasia

Finding Your Balance courtesy of NeurOptimal® — http://bit.ly/NeurOptimalBalance

Peak Performance courtesy of Kurt Othmer — http://bit.ly/NeurofeedbackPeakPerformance

The Science Behind NeurOptimal® courtesy of NeurOptimal® — http://bit.ly/NeurOptimalScience

Your Brain on NeurOptimal® courtesy of NeurOptimal® — http://bit.ly/NeurOptimalBrain

Neurofeedback Sessions Rate Motivated Client Specials

Single Session $100 Based upon demonstrated

need and after 5 paid sessions with retroactive savings

Seniors 62 and over, Students, Veterans* $80 Based upon demonstrated

need and after 5 paid sessions with retroactive savings

In-Home Client Visit/Transportation Fee $0.53/mile $0.42/mile (max 50 mi.)

* All Students (K-12, trade/vocation, college, university) and Veterans (military, law enforcement, and first responders). Mileage calculated and agreed upon at time of booking.



http://norcalneurofeedback.com/

Motivated Client Special Pricing Client pays for 5 Sessions and then moves on to HUGE savings in 2 for 1 pricing (pay every other

session) and extended discounts as training continues! With Optional discount to donate cost for someone else!

Session Number Price Savings (Based on $100/session) 1 Free $100 2 $100 3 $100 4 $100 5 $100 6 $100 7 $0 $100 8 $100 9 $0 $100

10 $100 11 $0 $100 12 $100 13 $0 $100 14 $100 15 $0 $100 16 $100 17 $0 $100 18 $80 $20 19 $0 $100 20 $80 $20 21 $0 $100 22 $80 $20 23 $0 $100 24 $80 $20 25 $0 $100

Total Cost and Savings $1320 ($52.80/session) $1180 Potential Savings

"From the beginning, the goal of chiropractic has been to normalize the patient’s neurology. Current research indicates that spinal adjustments influence cortical function, and that subluxations may in fact result from distortions of position sense in the CNS. NeurOptimal® is the only non-allopathic form of neurofeedback that relies on the patient’s innate wisdom for self-optimization. As such, I have found it to be the perfect complement to spinal adjustments." ~ Stevan Walton, D.C., FICC

"After having a very positive experience with NeurOptimal® myself in 2002 for sleep problems and anxiety, I decided in 2004 to bring it into my psychotherapy practice. It has proven to be an extremely complementary addition. I’m now doing neurofeedback more than I’m doing therapy, because it’s so effective, and because I like doing it so much. Some of my clients do both and I find that combination to be more effective than therapy alone." ~ Catherine Boyer, MA, LCSW New York Neurofeedback



http://norcalneurofeedback.com/

Motivated Student |Senior Citizen | Veteran Client Special Pricing Client pays for 5 Sessions and then moves on to HUGE savings in 2 for 1 pricing (pay every other

session) and extended discounts as training continues! With Optional discount to donate cost for someone else!

Session Number Price Savings (Based on $100/session) 1 Free $100 (Standard Cost) 2 $80 $20 3 $80 $20 4 $80 $20 5 $80 $20 6 $80 $20 7 $0 $100 8 $80 $20 9 $0 $100

10 $80 $20 11 $0 $100 12 $80 $20 13 $0 $100 14 $80 $20 15 $0 $100 16 $80 $20 17 $0 $100 18 $60 $40 19 $0 $100 20 $60 $40 21 $0 $100 22 $60 $40 23 $0 $100 24 $60 $40 25 $0 $100

Total Cost and Savings $1040 ($41.60/session) $1460 Potential Savings

"From the beginning, the goal of chiropractic has been to normalize the patient’s neurology. Current research indicates that spinal adjustments influence cortical function, and that subluxations may in fact result from distortions of position sense in the CNS. NeurOptimal® is the only non-allopathic form of neurofeedback that relies on the patient’s innate wisdom for self-optimization. As such, I have found it to be the perfect complement to spinal adjustments." ~ Stevan Walton, D.C., FICC

"After having a very positive experience with NeurOptimal® myself in 2002 for sleep problems and anxiety, I decided in 2004 to bring it into my psychotherapy practice. It has proven to be an extremely complementary addition. I’m now doing neurofeedback more than I’m doing therapy, because it’s so effective, and because I like doing it so much. Some of my clients do both and I find that combination to be more effective than therapy alone." ~ Catherine Boyer, MA, LCSW New York Neurofeedback


NorCal Neurofeedback Craig Walker, Certified Advanced NeurOptimal® Trainer¹ by the Zengar Institute

NeurOptimal® for Sports Performance Find ‘The Zone’ and Stay in it!

NeurOptimal (http://www.neuroptimal.com/) is for brain training and optimization and is otherwise exempt from FDA regulation because it does not diagnose or treat medical conditions and is not considered a medical device.

“Sometimes the biggest problem is in your head. You’ve got to believe.” ~ Jack Nicklaus “Competitive golf is played mainly on a five-and-a-half-inch course...the space between your ears.” ~ Bobby Jones

“The greatest discovery of my generation is that a human being can alter his life by altering his attitudes of mind.” ~ William James

Josh Brueckner uses NeurOptimal to help him stay mentally sharp

WXC welterweight champ AFC welterweight champ

MMA record (8-0) Trains out of: FUSE MMA

https://www.facebook.com/Joshbruecknermma https://twitter.com/JoshBrueckner

https://www.instagram.com/joshbrueckner/ https://youtu.be/lhXJKlL_myo

Upper left image courtesy of NeuroFitness Wellness Center-Southfield, MI

Athletic coaches know that the mental component of a sport is vital to success. It is critical to be “in the zone”. For most people, it is a challenge to change the way their brains work and subsequently their habits that sabotage their efforts and lessen their success. Neurofeedback easily facilitates success in athletic performance. Many elite Olympic athletes use neurofeedback training to supplement their rigorous physical training. Star athletes from the Olympics, NBA, NFL, and the LPGA have turned to neurofeedback for that mental advantage necessary to catapult them above and beyond the competition.

NeurOptimal is a highly evolved form of neurofeedback, which enables athletes to manage their mental and physical processes more effectively.

Created by Zengar Institute, NeurOptimal® is the most advanced neurofeedback technology available today. It has been used by athletes around the world to improve focus, alertness, flow, calmness, and many other physical and mental issues. It brings the benefits of peak performance to any sport to help you play better and enjoy your sport more.

Special rates on training packages for individuals and teams and free consultant package for system purchases. Free workshops with demonstrations provided to groups of 5 or more.


NorCal Neurofeedback and UnWind369 Craig Walker, Certified Advanced NeurOptimal® Trainer¹ by the Zengar Institute

Appointment Cancellation Policy Agreement:

NorCal Neurofeedback is committed to providing all of our clients with exceptional care. When a

client cancels without giving enough notice, they prevent another client from being seen.

Please call us at (530) 350-0169 by 2:00 p.m. on the day prior to your scheduled appointment to

notify us of any changes or cancellations. To cancel a Monday appointment, please call by 2:00

p.m. on Friday. If prior notification is not given, you will be charged $50.00 (50% full cost of a

session) for the missed appointment.

We understand that your time is equally important and if we must cancel an appointment without

the same advanced notice, your next visit with us will be no charge (a $100 value).

Please sign below to consent to these terms.

_______________________________________________________

Client Signature (Client’s Parent/Guardian if under 18)

_______________________________________________________

Print Client Name (Client’s Parent/Guardian if under 18)

_______________

Date



Adult Client Checklist Name: DOB: Session:

“The literature, which lacks any negative study of substance, suggests that EEG biofeedback (neurofeedback) therapy should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy, it would be universally accepted and widely used." ~ Frank Duffy, MD, Neurologist, Head of the Neuroimaging Department and of Neuroimaging Research at Boston Children’s Hospital, and Harvard Medical School Professor, conducted an independent review of the literature on neurofeedback for Clinical Electroencephalography (2000)"

Below is a list of problems that clients frequently describe to us. Please circle any that match your current concerns. If you are not sure whether to endorse an item, use the past week as a guide. Rate each item you identified from 1-10 with 1 being a mild concern and 10 being extremely problematic. Feel free to add any comments as necessary.

Attention & Organization Severity (1 – 10) Comments Difficult focusing Difficulty organizing activities Easily distracted Lose train of thought Make mistakes Behavior/Emotions Severity (1 – 10) Comments Angry Worry Anxious Anorexia Behaviors - Troublesome Bingeing Depressed Impulsive Mood swings Overwhelmed Panic attacks Paranoia Phobias - avoiding things Purging Racing Thoughts Repetitive Actions/Words/Thoughts Sad Bones/Joints/Muscles Severity (1 – 10) Comments Bodily fatigue Fibromyalgia Pain or stiffness in joints or muscles Bowel/Bladder Severity (1 – 10) Comments Difficulty controlling your bowels Difficulty holding your urine Difficulty urinating Frequent bladder infections Ear/Nose/Throat Severity (1 – 10) Comments Earaches Grinding your teeth


Ear/Nose/Throat (Continued) Severity (1 – 10) Comments Hearing loss Hoarseness or sore throat Nose or sinuses blocked Ringing in ears Sense of smell changed or lost Sense of taste changed or lost Eyes Severity (1 – 10) Comments Blind spots Double or blurred vision Spots in your vision Habits Severity (1 – 10) Comments Concerns about your diet Desire caffeine Other addictions Smoke cigarettes Sometimes drink too much Use marijuana Heart/Lungs Severity (1 – 10) Comments Dizziness Heart problems Hypertension Palpitations Problems breathing Hormonal/Blood Severity (1 – 10) Comments Appetite problems (e.g.wanting to eat when not hungry,etc)

Desire for sweets or carbohydrates Diabetes Excessive interest in sex Hot flashes Low interest in sex Other menopausal symptoms PMS symptoms Sensitivity to heat or cold Thyroid problems Immune System Severity (1 – 10) Comments Allergies Asthma Fatigue Frequent colds, infections Yeast infections Intestines Severity (1 – 10) Comments Nausea or vomiting Constipation

Gastric pain Gas or bloating Irritable bowel Diarrhea Nervous System Severity (1 – 10) Comments Blocking on words Difficult speaking


Nervous System (continued) Severity (1 – 10) Comments Fainting Headaches or migraines Hyperactivity Memory loss Motor or vocal tics Problems with balance Reading problems Seizures Tremor (shaking) Weakness School/Learning Severity (1 – 10) Comments Difficulty completing schoolwork Difficulty with particular subjects Getting into trouble at school Inverting letters/numbers Spatial problems (e.g. difficult building things, understanding how things should be put together)

Skin/Hair/Nails Severity (1 – 10) Comments Hair Nails Problems with skin Sleep Severity (1 – 10) Comments Difficulty falling asleep Difficulty waking up Nightmares or night terrors Sleep walking Snoring Wakeful or restless during night Waking up early Additional concerns to be tracked (Optional):

Severity (1 – 10) Comments

Current medications, dosage, and frequency (prescription and OTC):

Reminder: While many NeurOptimal® users have reported observing significant improvements in a variety of problem areas, the use of NeurOptimal® does not involve treating any medical or psychological conditions. The purpose of this list is purely to allow for the tracking of any changes over time. Thank you. Client Issue Severity Index: ____________ (to be completed by staff)



Child Client Checklist Name: DOB: Session:

“The literature, which lacks any negative study of substance, suggests that EEG biofeedback (neurofeedback) therapy should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy, it would be universally accepted and widely used." ~ Frank Duffy, MD, Neurologist, Head of the Neuroimaging Department and of Neuroimaging Research at Boston Children’s Hospital, and Harvard Medical School Professor, conducted an independent review of the literature on neurofeedback for Clinical Electroencephalography (2000)"

Below is a list of problems that clients frequently describe to us. Please circle any that match your current concerns. If you are not sure whether to endorse an item, use the past week as a guide. Rate each item you identified from 1-10 with 1 being a mild concern and 10 being extremely problematic. Feel free to add any comments as necessary.

Home Severity (1 – 10) Comments Allergies Anger outbursts Can stop activities (switch) Cleaning Up Continuous talking/monologue Correct Assessment of social queues Disruptive behavior while eating Disruptive behavior while eating Fear Fluid conversation Hyperactivity Maintaining continuous attention Making Eye Contact Obeying Obsessions/acts/tics Playing with other children Reckless endangerment Response to Challenges/irritabilities Sense Of Time Tantrums/Meltdowns Trouble with changes Understanding what is said Additional Comments:

D.A

Cross-Out


School Severity (1 – 10) Comments Anxiety homework and books in order Bag: Being bullied Being ready in time for school Bullying other children Concentration: dreaming Concentration: easily distracted Disruptive behavior Finishing homework Reading Reprimanded or sent out of the classroom

Starting homework Additional Comments:

Sleep/Getting Ready For The Day Severity (1 – 10) Comments Bed Wetting Difficulty falling asleep Dressing and showering Getting out of bed several times Getting up in the morning Nightmares Procrastination at bedtime Staying asleep throughout the night Additional Comments:

Current medications, dosage, and frequency (prescription and OTC):

Reminder: While many NeurOptimal® users have reported observing significant improvements in a variety of problem areas, the use of NeurOptimal® does not involve treating any medical or psychological conditions. The purpose of this list is purely to allow for the tracking of any changes over time. Thank you. Client Issue Severity Index: ____________ (to be completed by staff)

SETTING YOUR GOALSFill this out beFore you start your training with neuroptimal ®

1.

2.

3.

I will know NeurOptimal® is working if….

Put this in an envelope with your Checklist of Concerns and don’t look at it untul after you have filled in your next set of forms!

www.neuroptimal.com

NAME: DATE:

SESSION (CIRCLE) 1 10 20 30 40

Medication I am on: (how much, how often):

TRACKING YOUR PROGRESSFill this out in combination with the checklist of concerns before you start training and then every ten sessions.

CONCERNPick the concerns you circledthat you would like to change

the most. - Add any other concerns you want to track

FREQUENCYHow many times did you feelthis way in the past week, or

how many days out of 7?

INTENSITyHow strong was it 0-10

DURationHow long did it last?

Do not count when youwere sleeping

1.2.3.4.5.

Put this in an envelope with your Checklist of Concerns and don’t look at it until after you have filled in your next set of forms!

www.neuroptimal.com

NorCal Neurofeedback

NorCal Neurofeedback 4120 Cameron Park Drive, Suite 205

Cameron Park, CA 95682 (530) 350‐0169

http://NorCalNeurofeedback.com [email protected]

Dear Dr. ________________________________________ , Your patient, _________________________________________________ has consulted me for NeurOptimal® Neurofeedback training.

NeurOptimal® neurofeedback is considered by many to be the best neurofeedback training system in the field. It is completely non‐invasive and is designed to work with the brain as a non‐linear dynamical system. It does not “push” the brain in any way. NeurOptimal® "simply" and efficiently provides the brain with information about its own activity in real time. The client's brain then uses this information to organize itself, making it function more efficiently. NeurOptimal® does not diagnose or treat any disorder, it works by training the brain as a whole. When a client's brain optimizes itself, they are generally less symptomatic and will be able to function better within their diagnosis.

As a client progresses through training sessions their medication needs may shift. Often, but not always, a client is better able to utilize their medication and thus a reduction in dosage may become necessary. Of course, this decision is entirely between you and your patient and will be self‐evident during your regular evaluations. As I offer only NeurOptimal® training, I do not offer any suggestions related to the patient's diagnosis or treatment and will make it clear they need to consult you on these matters should they arise.

I appreciate the opportunity to work with your patient. Should you have any questions about NeurOptimal® training, please do not hesitate to contact me. I am enclosing my card with my contact information. Sincerely, Craig Walker Craig Walker Certified Advanced NeurOptimal® Trainer

Date post:	12-Feb-2019
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- NorCal Neurofeedback · Upper left image courtesy of NeuroFitness Wellness Center-Southfield, MI...

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