Liability

 

I,       AS NAMED ABOVE        , hereby release     MICHELLE IRVINE  from any liability or claims that could be made against her concerning my mental and/or physical well-being during  the work that has been outlined and agreed upon (now and in the future) by filling out this form. This liability waiver is not intended to exclude or restrict liability for death or personal injury caused by negligence.

 

 

Scope of Practice

 

I understand that MICHELLE IRVINE is not a licensed physician, psychologist, or medical practitioner of any kind and that hypnotherapy should not be considered a replacement for the advice         and/or services of a psychiatrist, psychologist, psychotherapist, or doctor.

 

 

Participation

 

I give MICHELLE IRVINE 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 recording for 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, MICHELLE IRVINE cannot and does not guarantee results since my own personal success  depends on many factors that MICHELLE IRVINE has no control over, including my willingness and desire to effect the changes inside myself.

 

 

Audio Recording(s)

 

I give MICHELLE IRVINE full permission to make audio recordings that may include my      voice. I understand that if a recording (or recordings) is made during or after my session(s)

MICHELLE IRVINE retains full copyright over any forms of media that may be produced     and distributed to me.

 

Deepening Process

 

I hereby grant permission to MICHELLE IRVINE 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 signing this form, I consent that MICHELLE IRVINE may release information to a specific  individual or agency if it has been determined that a vulnerable person (child or adult) is at risk; 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, MICHELLE IRVINE may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always unless I have given permission otherwise.