Safe and Sound Protocol UK

Vagus nerve stimulation based on Polyvagal Theory

Free Screening Tool

Please complete the form below to get an idea of whether the SSP is likely to be suitable for you and whether additional precautions would need to taken. Please answer all questions honestly. Whilst the SSP is safe and beneficial for the majority of people, a very small minority will experience adverse side effects. Knowing about pre-existing conditions helps me to keep you safe.

If the results indicate that there is no obvious reason the SSP wouldn’t be suitable for you, you will be sent a link to where you can purchase a full no-obligation SSP assessment. The full assessment will inform your individualised listening plan, should you decide to go ahead with the SSP.

Screening Tool

Initial screening

Details of the person interested in the SSP

First
Last

Medical information

Are you currently experiencing an episode of any of the following:
Have you been diagnosed with or do you think you may have any of the following:
Do you have a history of psychosis and / or antipsychotic medications?
Have you had a recent psychiatric hospitalisation?
Do you have any conditions related to the structures of the ear?
(eg perforated or ruptured eardrum, stapedectomy, typanostomy tubes)
Do you have sensitive hearing?
eg misphonia or hyperacusis
Do you have an autoimmune, neurological or other chronic condition?
Do you experience tinnitus that comes and goes?