client waiver form
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.
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.
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.
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.
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.
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.