Neurofeedback feedback Please enable JavaScript in your browser to complete this form.Name of Patient Name of person completing form (if different to above)Sleep issuesPlease describe any changes &/or any current issues in the 24 hours following NF. Note changes with: Issues getting to sleep, issues with waking, falling asleep in low stimulation environments, low energy levels, high energy levels, restless sleep, sleepwalking/talking, nightmares.SleepPoor & same as pre-NFBetter than pre-NFWorse than pre-NFNot applicable- no issues before NF or currentlyAttention skillsPlease describe if any changes &/or any current issues in the 24 hours following NF. Report changes in areas such as: attention/focus, distractibility, mind constantly on the go, fidgeting, issues sitting still, intruding in conversations and hyperactivity.Attention skillsPoor & same as pre-NFBetter than pre-NFWorse than pre-NFNot applicable- no issues before NF or currentlyMood ProblemsPlease describe changes in relevant areas such as: depression, low self-esteem, introversion, sensitivity, teariness, obsessiveness, being overwhelmed, anxiety, anger, irritability and agitation.Mood ProblemsPoor & same as pre-NFBetter than pre-NFWorse than pre-NFNot applicable- no issues before NF or currentlyBehavioural issuesPlease describe changes with: bedwetting, fighting with family or friends, physical or verbal aggression, impatience, and oppositional and defiant behaviour.Behavioural IssuesPoor & same as pre-NFBetter than pre-NFWorse than pre-NFNot applicable- no issues before NF or currentlyOther IssuesPlease describe any additional information regarding tics, headaches, migraines, teeth grinding, psychosomatic illness, or other targeted issues not mentioned above.Other IssuesPoor & same as pre-NFBetter than pre-NFWorse than pre-NFNot applicable- no issues before NF or currentlyCommentSubmit
