Client Consultation Waiver for Hypnosis,  Coaching and RTT (Rapid Transformational Therapy)

Liability: I, {name} hereby release the therapists (Michele Douthitt, the hypnotherapist/coach) from any liability or claims that could be made against him 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 the therapist is not a licensed physician, psychologist, or medical practitioner of any kind and that hypnosis should not be considered a replacement for the advice and/or services, of a psychiatrist, psychologist, psychotherapist, or doctor.

Participation: I give thereapist and coach full permission to coach or hypnotize me and to use RTT knowing that by participating fully in the process and by listening to my personalized recording for 21 days, I play an important role in my overall success.

Guarantee: I understand that although coaching, hypnotheripy and RTT has an incredibly high success rate, the therapist cannot and does not guarantee results since my personal success depends on many factors that the therapist has no control over, including my willingness and desire to affect the changes inside of myself.

Audio Recording(s): I give therapist 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) the therapist retains full copyright over any forms of media that may be produced and distributed to me.

Deepening Process: I hereby grant permission to therapist to respectfully lift my arm, touch my shoulder, or rock my head during my hypnosis and or RTT session(s) in order to help facilitate the deepening process.

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

Permission: I also understand that, at any time, the therapist may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always, unless I have given permission otherwise.

Client Agreement

I, {name}, understand that RTT (Rapid​ ​Transformational​ ​Therapy​) ​is​ ​a​ ​unique​ ​method​ ​that​ ​typically​ ​requires​ ​1​ ​-​ ​3 sessions​ ​to​ ​resolve​ ​most​ ​deeply-rooted​ ​issues.​ ​RTT​ ​uses​ ​hypnosis​ ​which​ ​is​ ​a completely​ ​safe,​ ​natural,​ ​and​ ​relaxing​ ​process​ ​where​ ​you​ ​will​ ​remain​ ​in​ ​control throughout​ ​the​ ​duration​ ​of​ ​your​ ​session. During​ ​RTT​ ​you​ ​will​ ​be​ ​regressed​ ​back​ ​to​ ​several​ ​memories​ ​in​ ​order​ ​to​ ​uncover where,​ ​when,​ ​how,​ ​and​ ​why​ ​you​ ​developed​ ​your​ ​presenting​ ​issue/problem.​ ​This insight​ ​will​ ​help​ ​you​ ​to​ ​gain​ ​a​ ​deeper​ ​understanding​ ​of​ ​the​ ​root,​ ​the​ ​cause,​ ​and the​ ​reason​ ​for​ ​your​ ​problem/issue.

I also understand that I ​play​ ​an​ ​active​ ​role​ ​in​ ​the​ ​successful​ ​outcome​ ​of​ ​my session(s).​ ​I will ​must​ ​be​ ​motivated​ ​to​ ​change​ ​and​ ​follow​ ​through​ ​with​ ​the process.

RTT​ ​is​ ​not​ ​meant​ ​to​ ​be​ ​a​ ​substitute​ ​for​ ​the​ ​advice​ ​or​ ​care​ ​of​ ​a​ ​qualified​ ​medical
professional.​ ​All​ ​information​ ​presented​ ​or​ ​recommended​ ​by​ the therapist ​is meant​ ​for​ ​educational​ ​purposes​ ​only.​ ​If​ ​you​ ​unsure​ ​about​ ​whether​ ​or​ ​not​ ​you should​ ​partake​ ​in​ ​an​ ​RTT​ ​session,​ ​please​ ​consult​ ​your​ ​general​ ​practitioner​ ​first.

Before​ ​taking​ ​part​ ​in​ ​your​ ​RTT​ ​session(s),​ ​please​ ​ensure that:

• you​ ​do​ ​not​ ​suffer​ ​from​ ​epilepsy.
• you​ ​will​ ​be​ ​free​ ​from​ ​the​ ​influence​ ​of​ ​drugs​ ​or​ ​alcohol​ ​during​ ​the course​ ​of​ ​your​ ​session.
• you​ ​provide​ ​me​ ​with​ ​the​ ​correct​ ​address​ ​of​ ​your​ ​online​ ​location.
• the​ ​environment​ ​around​ ​you​ ​is​ ​safe​ ​and​ ​will​ ​remain​ ​distraction​ ​free.
• you​ ​provide​ ​me​ ​with​ ​a​ ​phone​ ​number​ ​or​ ​other​ ​means​ ​of communication​ ​to​ ​contact​ ​you​ ​with​ ​in​ ​the​ ​case​ ​of​ ​a​ ​technology​ ​failure.
• you​ ​provide​ ​your therapist ​with​ ​a​ ​third-party​ ​emergency​ ​contact​ ​number.