client waiver form

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Liability
I, the Client, hereby release Natalie Mears (the hypnotist) from any liability or claims that could be made against (her) concerning my mental and/or physical wellbeing during the work that has been outlined and agreed upon (now and in the future) by filling out this form.


Scope of Practice
I understand that ​Natalie Mears is not a licensed doctor, psychologist, or medical practitioner of any kind and that hypnosis should not be considered a replacement for the advice and/or services, e.g. psychiatrist, psychologist, psychotherapist, doctor.

 

Participation
I give​ Natalie Mears full permission to hypnotise me and to use Rapid Transformational Therapy™ knowing that by participating fully in the process and by listening to my personalised audio recording for at least 21 days I play an important role in my overall success.


Guarantee
I understand that although Rapid Transformational Therapy™ has an incredibly high success rate, ​Natalie Mears ​cannot and does not guarantee results since my own personal success depends on many factors that​ Natalie Mears has no ​control over, including my commitment, willingness and desire to affect the changes inside of myself.

 

Audio Recording(s)
I give​ Natalie Mears​ full permission to make audio recordings that may include my voice. I understand that if a recording (or recordings) are made during or after my session(s) Natalie Mears ​retains full copyright over any forms of media that may be produced and distributed to me.


Deepening Process
If doing a face-to-face session, I hereby grant permission to ​Natalie Mears to respectfully lift my arm, touch my shoulder, or rock my head during my Rapid Transformational Therapy™ session(s) in order to help facilitate the deepening process.

 

Confidentiality
By electronically signing this form, I consent that Natalie Mears may release information to a specific individual or agency if it has been determined that a child or adult is at risk of or is currently being abused or; if I, as a client, am in imminent danger to myself or others; or if a subpoena of records has been requested.


I also understand that, at any time, Natalie Mears ​may discuss aspects of my case with other colleagues keeping my name and identity completely confidential, unless I have given permission otherwise.