ENSELE "A CENTER FOR HEALING NATURALLY"
Meditation & Events
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In order to submit to your insurance, please fill out your date of birth & address.
Email the front and back of your insurance card to email@example.com. An added bonus is to also ask your doctor to write a prescription to have neurofeedback and infrared light therapy as needed due to X.
Name of Insurance
Date of Birth
Frequent colds, infections
Problems with skin
Problems with hair
Problems with nails
Ringing in ears
Headaches or migrains
Blanking on words
Tremors or shaking
Problems with balance
Motor or vocal tics
Difficulty completing schoolwork
Getting into trouble at school
Inverting letters and numbers
Spatial problems (i.e. difficulty building things, understanding how things should be put together)
Difficulty with particular subjects
Attention and Organization
Difficulty holding urine
Difficulty controlling bowls
Frequent bladder infections
Nausea or vomiting
Gas or bloating
Pain or stiffness in joints or muscles
Sore trigger points
Nausea or vomiting
Gas or bloating
Difficulty falling asleep
Wakeful or restless during night
Difficulty waking up
Nightmare or night terrors
Appetite problems (e.g. wanting to eat when not hungry)
Desire for sweets or carbohydates
Sensitivity to heart or cold
Other menopausal symtoms
Low interest in sex
Excessive interest in sex
Double or blurred vision
Spots in your vision
Sometimes drink too much
Concerns about diet
Feeling down, depressed or flat
Thoughts that won't leave your mind
Need to repeat actions or words over and over
Restricting your food intake
Making yourself vomit
Phobias - avoiding things
Feeling others are against you
Behaviors that get you into trouble
Feeling angry a lot
Now from the items above list 3 goals that are most important to you.
What medications are you taking?
PLEASE ADD ANYTHING ELSE YOU WOULD LIKE TO COMMENT ON HERE:
How to get the most from your Brain Optimization Sessions
*Please confirm your understanding by checking the boxes*
Every brain, and every human path, is unique. The brain is our most complex organ, far beyond full human comprehension by scientific or other means, at this time. Just as our skin can heal itself of a wound, and our digestive organs can clear away waste or toxins, so too does the brain have tendencies for bringing itself into balance. The purpose of Brainwave Optimization is simply to give the brain information about its own activity, so it can be supported in its self-balancing – just as we can adjust our appearance by looking into a mirror. Because every brain will have different “tasks” for its self-balancing, based on its own unique traits and a person’s unique life history and intended path, every person’s experience of Brainwave Optimization will be different.
I am a unique human being with a unique brain, and my experience will be unique to me.
During the actual sessions, it is my own brain that will be “doing the work”, listening to its rhythms through an acoustic mirror and making self-adjustments in its own way, in its own time. Anything and everything that follows from Brain Optimization, is a consequence of my own brain’s unique path to self-optimization, my own history, and my own choices.
I have a Vision, Goals, or Intentions When the brain is relaxed, it is easier to make positive changes in one’s life, to create momentum toward the unique direction that is suited for oneself and no other. Please ask yourself some or all of the following questions. What is my true potential? What would I like to experience, contribute, or achieve in my life? What do I feel truly moved to do? What choices am I making, with respect to the circumstances of my life?
I will care for myself. There are many ways that the brain can be supported to optimize its own functioning. Patterns of sleep, physical activity, nutrition, social interactions, attitude, and other features of our lifestyle and choices have meaningful impacts on brain activity and life experience.
During my sessions, and for at least 3 weeks afterwards, I can support my brain’s own optimization process. At my discretion, I may consider: Making conscious decisions to limit or avoid certain habits that do not support my overall wellness goals, Observing my own way of responding to stress, as well as my thoughts & perspective, Noticing how I breathe throughout the day, how I sit, stand and carry myself, Deciding if it feels best to either include or avoid other activities in order to allow my brain the space to optimize, Supporting my physical body with extra rest and/or sleep (if needed) as well as satisfying exercise that I enjoy, Making food and drink choices to nourish my physical, mental & emotional wellbeing, Being attentive to my sleep habits, so I can use sleep as a healthful means for regular rejuvenation, Listening to my WaveAid nature sound daily, after my sessions are complete, to further support my brain’s ongoing self-optimization. *
I will be mindful of influences on a Brain’s tendency to optimize itself Everything we do has the potential to impact our brain’s innate tendency to relax and optimize its own functioning. Certain things I may be doing in my life have potential to compete with, or support, my brain’s tendency to optimize its activity, and whether I decide to change, limit or avoid any of these influences is my choice and responsibility. These might include: Nutritional & lifestyle factors, including alcohol & recreational drug use Medications & supplements, especially those that are intended to impact brain functioning Other interventions, for example counseling, physical therapy, surgery, botox, etc. Conversely, as my brain optimizes itself, I may experience changes in the way that I, or my body, respond to these and other influences. *
ONLY I, in conjunction with my medical provider, can make any changes to my prescription drug usage. *
I will be aware that the Brain may change itself in unexpected ways The brain is the master regulator of life experience. As brain activity changes, the way we experience life at any level—physically, mentally, emotionally or spiritually – has the potential to change. Sensitivity to Change: During Brainwave Optimization®, please be aware that the brain will go through a series of shifts and changes as it moves towards a more optimized and balanced state. Most of our clients do not notice these shifts as they are occurring. However, clients who tend to be more sensitive to emotions, foods, medications, allergens, pollutants, sounds and/or the moods of others, also tend to be more sensitive to the shifts as they occur during Brainwave Optimization®. These shifts may be experienced as a heightened emotionality, changes in usual sleep patterns or dreams, and/or shifts in energy levels. While temporary, these changes can be uncomfortable, and we advise that you adjust your life demands and schedule if possible to accommodate rest during this time.
During my sessions, I may notice differences in the way I experience sleep patterns & dreams mood and emotional experience sensitivity to myself and others, to my environment, and to anything I ingest, including my medications physical energy level. *
As my brain “sees” itself through the acoustic mirror, it has the opportunity to deeply relax and release potential “stuck” patterns. As these patterns shift, there is a risk to experience changes I did not anticipate. *
If I have questions or concerns about my own ability to experience this potential type of shift I will let my technologist know immediately. I can help myself before undergoing sessions by setting up my own support team of trusted healthcare providers, family members and/or friends. *
I will work together to create the most optimal experience! In order to give my brain the most time to reach a state of deep relaxation during a session, I am responsible for being on time. If I am late, my session time will most likely be shortened. Should something arise and I cannot make a session, I will do my best to give at least 24 hours notice and reschedule. Otherwise I may forfeit the cost of the session. *
Sessions last approximately 2 hours While you are with us, you may be working with more than one technologist Dress comfortably so that you can truly relax in the chair No outside food or drinks, no eating during sessions. Water is provided. No gum chewing, or items in mouth. No cell phone or device usage, please set them to “off” or “silent” Do your best to “let go” of the process and trust your own brain Water and protein are the building blocks of the brain. Outside of sessions, consider drinking ½ your body weight in ounces each day and increasing your protein intake (extra servings; protein shakes, bars). *
(c) ENSELE 2009-2018
Meditation & Events