INFORMED CONSENT FOR GROUP PSYCHOLOGICAL SERVICE The Deep Nervous System Reset Dr. Chris Friesen, Ph.D., C.Psych. Niagara Neuropsychology & Friesen Sport and Performance Psychology 289-235-8848 | [email protected] CPBAO Registration Number: 4688
NOTE TO PARTICIPANT: Your informed consent is required before participating in this service. Please read the following carefully. If you have any questions, contact us at [email protected] before your first session.
- Nature and Purpose of the Service
The Deep Nervous System Reset is a weekly drop-in group psychological service delivered via Zoom. It is facilitated by Dr. Chris Friesen, Ph.D., C.Psych., a registered psychologist in Ontario.
Each 60-minute session combines evidence-based techniques for nervous system regulation including RSA breathing and HRV training, structured movement drills, autogenic training, attentional focus training, progressive muscle relaxation, guided imagery, and deep guided relaxation using hypnotherapeutic techniques.
This service is not individual psychotherapy, psychological assessment, or crisis intervention. It does not constitute an ongoing therapeutic relationship between Dr. Friesen and participants. If you require individual psychological services, please contact our office directly.
- Potential Risks and Benefits
Benefits may include reduced stress and anxiety, improved sleep quality, improved emotional regulation, increased heart rate variability, and greater capacity to manage the demands of high-performance environments and daily life.
Potential risks include:
- Temporary emotional discomfort or the surfacing of difficult emotions during relaxation or guided imagery exercises
- Dissociative experiences in individuals with a history of trauma
- Physical discomfort during movement components
- Technology failures that may disrupt the session
- Reduced privacy inherent in virtual delivery
If you have a history of trauma, dissociation, psychosis, or other significant mental health concerns, we recommend consulting with your treating mental health professional before participating.
Alternatives to this service include individual psychological therapy, self-guided relaxation programs, and other group wellness programs.
- Virtual Care
This service is delivered entirely via Zoom. By participating you acknowledge:
- You understand the privacy limitations of electronic communication and virtual platforms
- You are responsible for ensuring you participate from a private environment where you will not be overheard or interrupted
- Technology failures may occur and are outside Dr. Friesen’s control
- Sessions are not recorded by Dr. Friesen or his staff
- You agree not to record any portion of the session yourself
- In the event of a technology failure during a session, you may rejoin using the same Zoom link or contact [email protected]
- Emergency Procedures
The Deep Nervous System Reset is not a crisis service. Dr. Friesen is not able to provide emergency or crisis support during group sessions.
If you experience significant distress during a session, you are free to leave the session at any time. If you are in crisis or require immediate support, please contact:
- Crisis Services Canada: 1-833-456-4566
- Distress Centre of Niagara: 905-688-3711
- 911 or your local emergency services
- Confidentiality and Its Limits
Dr. Friesen and his staff will keep your personal information confidential in accordance with the Personal Health Information Protection Act (PHIPA) and applicable professional standards.
There are specific exceptions to confidentiality. Your information may be disclosed without your consent when:
- There is reason to believe you may be a danger to yourself or others
- There is reason to believe a child or vulnerable person is at risk of abuse or neglect
- You report to us that you have been sexually abused by a health professional
- Your information has been subpoenaed by a court of law
Group confidentiality: Because this is a group service, Dr. Friesen cannot guarantee the confidentiality of information shared by other participants. By participating you agree to respect the privacy of other participants and not to share any personal information disclosed by others during the session.
- Fees, Billing, and Cancellation
The cost is $85 CAD per session. Payment is collected at the time of booking via Stripe.
Sessions may be submitted to your insurance provider as a Group Psychological Service facilitated by a registered psychologist in Ontario. An official receipt will be provided following each session. Please do not submit your Stripe payment receipt or Calendly confirmation to your insurance provider.
Sessions are non-refundable. Cancellations made more than 24 hours before the session will receive a credit toward a future session. Cancellations within 24 hours of the session are not eligible for a credit.
- Your Rights
Participation in this service is entirely voluntary. You may withdraw your consent and discontinue participation at any time. Withdrawal will not affect your access to any other services provided by Dr. Friesen or his clinic.
If you are under 18 years of age, by checking the consent box below you confirm that you have obtained parental or guardian permission to participate in this service.
- Facilitator Qualifications
This service is designed and facilitated by:
Dr. Chris Friesen, Ph.D., C.Psych. Licensed Clinical Psychologist, Neuropsychologist, and Sport and Performance Psychologist. Registered with the College of Psychologists of Ontario. Board certified in biofeedback, neurofeedback, and HRV-biofeedback. CPBAO Registration Number: 4688
- Consent
By checking the consent box at booking I confirm that:
- I have read and understood the information above
- I have had the opportunity to ask questions before consenting
- I understand the nature, risks, and benefits of this service
- I understand that this is not individual psychotherapy or crisis support
- I consent to participate in the Deep Nervous System Reset
- I agree to respect the confidentiality of other participants
- I agree not to record any portion of the session
- I understand the cancellation and refund policy
- I understand my rights including the right to withdraw at any time
The date and time of my consent is recorded automatically at the time of booking.
