RESEARCH SUMMARY
This project is an educational and observational research initiative designed to explore patterns of brain activity and self-regulation in adult participants engaged in wellness-based neurofeedback and brain mapping experiences. Participants voluntarily provide non-diagnostic brain data and self-reported feedback for the purpose of program evaluation, training, and exploratory research. No medical diagnosis or treatment is provided. Data collected will be de-identified and analyzed in aggregate to support educational insights, quality improvement, and public awareness initiatives. Participation involves minimal risk and may offer potential benefits related to self-awareness, learning, and personal development. All participation is voluntary and may be withdrawn at any time without penalty.
PROGRAM DESCRIPTION
I understand that I am voluntarily participating in a wellness and educational program that may include:
• qEEG brain mapping (quantitative electroencephalogram)
• Neurofeedback or brain training sessions
• Educational discussions related to brain patterns, stress, focus, or self-regulation
• Optional photography, video, and testimonial documentation
I acknowledge that these services are not medical or mental health treatment, and are provided for educational, personal development, and wellness purposes only.
NON-CLINICAL AND NON-DIAGNOSTIC ACKNOWLEDGMENT
I understand and agree that:
• Brain mapping and neurofeedback are not diagnostic tools
• No medical, psychiatric, or therapeutic claims are being made
• No diagnosis, treatment, or cure is being offered
• This program does not replace medical or mental health care
I am responsible for consulting licensed professionals for any medical or psychological concerns.
VOLUNTARY PARTICIPATION AND RIGHT TO WITHDRAW
I acknowledge that:
• My participation is completely voluntary
• I may stop or withdraw at any time without penalty
• Declining participation will not affect my access to other services
DATA USE AND OBSERVATIONAL RESEARCH CONSENT
I consent to the collection of my brain data and session notes for:
• Educational purposes
• Program evaluation and quality improvement
• Observational or exploratory research
• Internal training and demonstration
All data will be:
• De-identified when used externally
• Stored securely
• Never sold
• Never shared with third parties without my consent
PHOTOGRAPHY, VIDEO, AND MEDIA RELEASE
I grant permission for the organization to capture and use:
• Photographs
• Video recordings
• Audio recordings
• Written or verbal testimonials
These materials may be used for:
• Educational presentations
• Grant reporting
• Program documentation
• Websites, newsletters, and social media
• Public awareness and outreach
I understand that:
• No financial compensation is provided
• My name and identifying details will not be used without explicit permission
• Media may be edited for clarity or length
CONFIDENTIALITY AND PRIVACY
I understand that:
• Personal health information will not be disclosed
• Any public use will be anonymized unless I approve otherwise
• I may request removal of identifiable media at any time
NO GUARANTEE OF OUTCOMES
I understand that results vary and that there is no guarantee of specific outcomes or benefits from participation.
LIABILITY WAIVER
I release and hold harmless the organization, staff, volunteers, and partners from any claims related to my participation in this educational and wellness program.
INFORMED CONSENT
By signing below, I confirm that:
• I have read and understood this form
• I had the opportunity to ask questions
• I consent freely and voluntarily