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 | NiagaraNeuropsychology@gmail.com
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 NiagaraNeuropsychology@gmail.com 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
• Temporary lightheadedness, tingling, or drowsiness during or after the breathing and relaxation components
• Physical discomfort, muscle soreness, strain, or falls during the 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.

Physical Participation and Medical Fitness

Each session includes about 15 minutes of gentle standing movement, followed by a guided sequence done lying down. The physical effort is similar to an easy walk. You are responsible for working within your own comfort zone, resting or modifying any movement as needed, and stopping if you feel pain, dizziness, or shortness of breath.

Sessions are delivered virtually, and participants’ cameras and microphones are off. Dr. Friesen cannot see, hear, supervise, or assist you, and will not know if you are having difficulty. You need to be able to move independently, including getting down to and up from the floor, and to have a clear, safe space to participate in.

Some techniques involve brief breath holds, slow paced breathing, and tensing of muscle groups. If you are pregnant, have a cardiovascular or respiratory condition, uncontrolled high blood pressure, a seizure disorder, a recent surgery or injury, or any doubt about whether you are medically fit to participate, please get clearance from your physician before your first session. You can skip the breath holds and muscle tensing at any time and breathe normally.

Do not participate while driving or doing anything that requires your full attention. You may feel drowsy afterward, so give yourself a few minutes before driving or returning to demanding tasks.

There is an inherent risk in any physical activity. By participating, you accept responsibility for taking part within your own limits and for the safety of the space you participate in.

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
• Participants’ cameras and microphones are off during sessions. Your display name may be visible to other participants, and you can change it at any time
• 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 NiagaraNeuropsychology@gmail.com

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. Because sessions are virtual, cameras and microphones are off, and participants join from many locations, Dr. Friesen will not know if you need help and is not able to send help to you. You are responsible for contacting emergency services yourself if you need them.

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:

• 9-8-8 Suicide Crisis Helpline: call or text 9-8-8, available 24 hours a day across Canada and the United States
• 911 or your local emergency services
• Your nearest hospital emergency department

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

Records: Brief polls are completed before and after each session. Your responses and attendance form part of your record, which is kept securely as required by professional standards. Poll results may be used in de-identified, grouped form to evaluate and improve the program.

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. Coverage varies by plan and by where you live, so if you are participating from outside Ontario, please confirm coverage with 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 at booking 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. Registered Clinical Psychologist, Neuropsychologist, and Sport and Performance Psychologist. Registered with the College of Psychologists and Behaviour Analysts of Ontario (CPBAO). 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 know of no medical reason why I should not participate, and I understand that getting medical clearance is my responsibility if I have any doubt
• I understand that the movement and breathing components carry inherent physical risks, that I am participating unsupervised in my own space, and I accept responsibility for participating within my own limits
• I understand that Dr. Friesen cannot see or hear me during the session and that I am responsible for contacting emergency services myself if I need them
• 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.