Application for a Certificate in HRV Biofeedback

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The Biofeedback Certification International Alliance

Application for a Certificate in HRV Biofeedback

Please complete this form, providing documentation as instructed in each item below. To be considered, applications must include signature and filing fee.

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First   Middle   Last   (Degree for certificate, optional - this information will be printed on your certificate.)

License/Credential for Independent Practice

When treating a medical or psychological disorder, you are required to hold a current health care license or agree to work under the supervision of an appropriately credentialed health care professional.   This credential in a BCIA approved health care field must be issued or recognized by the state in which you practice.

If you do not have an electronic copy of the above documents, you may fax it to (303) 422-8894 or mail to the address below, in the web footer.

Didactic Education

Blueprint – Completion of 15 hours of didactic course work from a BCIA-approved HRV biofeedback didactic program(s) that fully covers the BCIA HRV blueprint.

Cardiac Anatomy/Physiology 1 hour HRV Instrumentation 3 hours
Respiratory Anatomy/Physiology 1 hour HRV Measurements 2 hours
ANS Anatomy/Physiology .5 hours HRV BF Strategies 4 hours
Heart Rate Variability 2 hour2 HRV BF Applications 1.5 hours

 

Ethics/Professional Conduct - Completion of 3 hours of course work taken within the last 5 years:  BCIA accredited training programs, university or national professional organizational courses, BCIA webinars or CE articles, etc. as would be appropriate for BCIA certification or recertification. 

Please include copies of certificates of completion documenting completion of these requirements.

Exam.  When you have been notified that your application has been accepted, you may make plans to take your written exam either at a scheduled exam site or by using the online special exam option.

Agreement

1. I, the undersigned, do hereby make voluntary application to the Biofeedback Certification International Alliance – formerly the Biofeedback Certification Institute of America (BCIA). I certify that the information given by way of this application is true, honest, and completely represents me.

2. I will conform to all applicable local, state, and federal regulations and conduct myself consistent with the highest standards relating to my profession and specialty.

3. I have received, read and agree to be bound by the BCIA Professional Standards and Ethical Principles of Biofeedback (PSEP) and their policies and procedures. I understand that the PSEP and any BCIA policies and procedures may be amended from time to time and that I am bound by these documents as amended. I also understand that in accordance with such policies and procedures:

(a) the final determination of any dispute arising between me and BCIA will be made by its board of directors and that I will be bound by the board’s determination and may not seek review;

(b) however, if grounds exist that would permit a court to overturn or modify the board’s determination or otherwise act in the matter, that I will seek redress only in Denver, CO and only by arbitration in accordance with such policies and procedures; and

(c) because I have agreed that the board’s determination is final and binding upon me, I am likely to be required to pay the costs, reasonable attorney fees and other expenses of BCIA in any proceedings instituted by me.

4. I understand and agree that BCIA and its affiliates assume no responsibility for my actions or activities. I practice at my own risk and hereby release BCIA from any and all liability from any practice decisions I make.

5. I hereby give permission to BCIA to contact individuals or agencies listed for verification of information submitted. I recognize that failure to do so may result in disciplinary action including suspension or revocation of my certification.

BCIA reserves the right not to accept your application based on any information submitted. To be considered, applications must include signature and filing fee.

Filing fee:  $25 for BCIA certificants or students pursuing a BCIA approved health care degree from a regionally accredited academic institution or $50 for all other interested professionals.

 

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