Liability

I, The Client, (add your name) .............................................................................................. hereby release Nathalie Crittenden-Lopis, Your therapy and wellbeing yourtherapyandwellbeing.com, 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 Nathalie Crittenden-Lopis, Your therapy and wellbeing yourtherapyandwellbeing.com, is not a licensed doctor, physician, psychologist, or medical practitioner of any kind, and that hypnotherapy and RTT ® therapy should not be considered a replacement for the advice and/or services of a psychiatrist, psychologist, psychotherapist, or doctor.

Participation

I give Nathalie Crittenden-Lopis, Your therapy and wellbeing yourtherapyandwellbeing.com, full permission to hypnotize 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, Nathalie Crittenden-Lopis Your therapy and wellbeing yourtherapyandwellbeing.com can not, and does not guarantee results, since my own personal success depends on many factors that Nathalie Crittenden-Lopis has no control over, including my willingness and desire to effect the changes inside myself.

Audio Recording(s)

I give Nathalie Crittenden-Lopis, Your therapy and wellbeing yourtherapyandwellbeing.com, 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), Nathalie Crittenden-Lopis, Your therapy and wellbeing yourtherapyandwellbeing.com, retains full copyright over any forms of media that may be produced and distributed to me.

Deepening Process

I hereby grant permission to Nathalie Crittenden-Lopis, Your therapy and wellbeing yourtherapyandwellbeing.com, to respectfully lift my arm, touch my shoulder, touch my forehead, or rock my head during my Rapid Transformational Therapy® session(s) when in person, in order to help facilitate the deepening process.

Confidentiality

By signing this form, I consent that Nathalie Crittenden-Lopis, Your therapy and wellbeing yourtherapyandwellbeing.com, 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, Nathalie Crittenden-Lopis, Your therapy and wellbeing yourtherapyandwellbeing.com, may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always, unless I have given permission otherwise, or in cse of safeguarding.

I consent to all the above (add your initials ..................)

Therapist signature: Nathalie Crittenden-Lopis,

Your therapy and wellbeing yourtherapyandwellbeing.com

Client signature: ...................................................

Date: .....................................