Informed Consent for Neurotherapy and Energy Therapies
Welcome to the Infinite Potential Institute, LLC. We are practitioners who utilize neurotherapies as well as therapies which support the subtle energy flow of the body. We are not licensed physicians, nor are neurotherapy services licensed by the states. We do not provide written reports, updates, analysis, or diagnoses.
Neurofeedback is a non-invasive, FDA approved training method using auditory, visual, or proprioceptive feedback to encourage the improvement of brain functioning. It supports the balance of the central nervous system and can significantly reduce symptoms. An EEG cap measures brain functioning for further analysis. The brain’s electrical information is sent to the software, which translates it into information about brain activity. Feedback is given to the client visually through a computer screen. This way the brain learns through positive reinforcement.
Sound-Vibration Therapy (SVT)
Sound-Vibration Therapy aims at balancing the subtle energy fields of the body by supporting a free, unblocked energy flow. Through vibration and sound the energy flow is strengthened and energy blockages are resolved to promote self-healing and wellness. It uses sound waves produced by specialized tuning forks in the biofield that surrounds the human body. During a standard Sound-Vibration Therapy session, the practitioner uses some hands-on touch and applies the handles of tuning forks and crystals to the body. The theory of energy therapies is that the flow and balance of the body’s electromagnetic and subtle energies is important for physical, spiritual, and emotional health, and for fostering overall well-being.
Esoteric Acupressure (EA)
EA aims at harmonizing and re-aligning more subtle energy fields of the body by activating specific anatomical points on the body surface. Similar to Traditional Chinese Medicine (TCM) a more subtle energy system of the body is presumed. It is theorized that we have a blueprint that is unique to each individual and that by slightly pressing certain points on the body surface a re-alignment with that blueprint is facilitated. Being more aligned with our blueprint is theorized to be beneficial for a more balanced mind and body.
Pulsed Electro Magnetic Field Stimulation (pEMF)
We are using an FDA approved pEMF device that is designed to reduce stress and energetically balance the human body. This technique is designed to deliver very weak electrical pulses to the energy field that is generated by the human brain and body. It is theorized that the energy field created by the brain and body can be influenced by neighboring energy fields and that this may support optimal functioning of tissue. It is also theorized that this process supports the healing process.
In order to further the client’s understanding and regulation of his/her own mind-body functioning, supplementary methods of autonomic biofeedback may be employed during sessions, which could include measurements of heart rate variability, muscle tension, temperature and/or skin conductance.
Infinite Potential Institute practitioners are not physicians and not medical doctors.
Dr. Stella Wuttke, PhD. Msc. Bcs.
Stella holds a bachelor, master, and doctoral degree in Psychology and is a Cognitive Neuroscientist, Sound-Vibration Therapy practitioner, and Meditation Teacher. She is an EEG expert and acted as a post-doctoral principal investigator (PI) for a state-funded EEG project on brain wave patterns associated with visual perception. She was lab-director of the neurofeedback laboratory at the University of Jena, Germany. She is the principal investigator of a project on meditation and neurofeedback as well as of a study on autism and neurofeedback including pre- and post-EEG testing that is a collaboration with the University of Jena. Stella is specialized in Neurotherapies, Biofield Tuning, and Esoteric Acupressure.
A. Martin (Marty) Wuttke - pioneer and international renowned expert
With over 35 years experience, Marty is a clinician, author, counselor, and certified by BCIA and international QEEG certification board. He was affiliated with Ridgecrest Hospital and Woodridge Psychiatric Hospital from 1983 – 1997 where he designed and directed the first large scale inpatient Neurofeedback program in the US. Neurofeedback was used at the hospital as an integral part of the treatment program. Over 14 years of application and well over 1500 patients went through Neurofeedback training. He is a co-creator of Jacobs Ladder a neurodevelopmental center and formerly CEO of the Wuttke Institute. He is also a speaker, a teacher, and a trainer for professionals in Neurotherapy both in the US and internationally.
1. Our method of therapy is alternative or complementary to healing arts that are licensed by the State of California. Under Sections 2053.5 and 2053.6 of California’s Business and Professions Code, these services can be offered to you subject to the requirements and restrictions included in SB-577.
2. For some, sessions can bring to the surface uncomfortable and/or deeply personal emotions. Clients sometimes feel fatigued, headachy, fuzzy thinking, vulnerable, tender, or uneasy. This is a part of the healing process as the brain integrates the feedback and builds new neuropathways. If you have any concerns about the nature of your training, please feel free to discuss them with us. We aim to support clients through this process. However, we recommend that you inform your current medical doctor, therapist, and/or psychologist that you are receiving Neurotherapy training. It is the client’s responsibility to monitor the effects of their training sessions and determine whether or not they are beneficial.
3. We do not offer diagnoses of any kind, nor do we treat diagnoses. EEG analyses and qEEG brain maps are not intended to provide a diagnosis but are used to evaluate the state of dysregulation of the brain. Our services are designed to be complimentary, not to replace any other medical or healthcare service or treatment. Any medical questions should be addressed to the client’s physician. If you do not have a relationship with a medical doctor and/or therapist, we strongly urge you to create one at this time.
The client agrees to take full responsibility for his/her experience, the benefit of such training, or the lack thereof, and further agrees to hold the Infinite Potential Institute, LLC and its owners, practitioners, employees, contractors and agents harmless from all claims associated with the services provided.
In order to use our services, California or Georgia state law requires that you acknowledge receipt of the information provided in this form and that you sign it. We will keep the original in our records for at least three years.
Acknowledgement and Consent to Receive Services
I have read and understand the above disclosure about the services offered by the Infinite Potential Institute (IPI) and the experience and training of its practitioners. I have discussed with them the nature of the services to be provided. I understand that they are not licensed physicians and that Neurotherapy services are not licensed by the state of California or Georgia. I understand it is my responsibility to maintain a relationship for myself/my child with a medical doctor. I have consented to use the services offered by the Infinite Potential Institute and agree to be personally responsible for the fees in connection with the services provided to me.
By signing this form, the client indicates his/her understanding of the principles set forth above and waives any claim of damages due to any services provided by the IPI, including worsening of the client’s condition for which the training was undertaken, any claimed side effects, or the failure to improve with training. The client agrees that the data obtained in connection with these trainings may be used in publications with protection of the privacy and preservation of the anonymity of the client.
I agree, by signing this form, that all of the above provisions apply to training provided by the Infinite Potential Institute and any practitioner or assistant/intern it may have.
For Energy Therapies, I grant my Energy Therapist permission to use hands-on touch and the application of tuning forks and crystals to my body. I am aware that I may verbally revoke this permission at any time before, during, or after a session.
Signature of both parents who hold legal custody is required in the treatment of a minor.