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Client Disclaimer Form

Liability

I,  __________________________________ the client, hereby release Emma Everest 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.

Scope of Practice

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

Participation

I give Emma Everest full permission to hypnotise me and to use Rapid Transformational Therapy, and 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 Emma Everest cannot and does not guarantee results, since my own personal success depends on many factors that Emma Everest has no control over, including my willingness and desire to affect changes.

Audio Recording(s)

I give Emma Everest full permission to make an audio recording that may include my voice.  I understand that if a recording/s are made during, or after my session/s Emma Everest retains full copyright over any forms of media that may be produced and distributed by me.

Deepening Process

I hereby grant Emma Everest to respectfully lift my arm, touch my shoulder or rock and/or touch my head during my Rapid Transformational Sessions/s, in order to help facilitate the deepening process.

Confidentiality

By signing this form I consent that Emma Everest may release information to a specific individual or agency, if it has been determined that a vulnerable person is at risk; if I as the 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 Emma Everest may discuss aspects of my case with other colleagues keeping my full name and identity completely confidential always, unless I give permission otherwise.

Full Name:


Date:

                                                                                      Signature:

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