DISCLAIMER FORM

Liability

I, (The Client), hereby release Terry Alexander 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 Terry Alexander 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 Terry Alexander 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, Terry Alexander  cannot and does not guarantee results since my own personal success depends on many factors that Terry Alexander has no control over, including my willingness and desire to affect the changes inside of myself.

Audio Recording(s)

I give Terry Alexander 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) Terry Alexander retains full copyright over any forms of media that may be produced and distributed to me.

Deepening Process

I hereby grant permission to Terry Alexander to respectfully touch my hands and forearms, lift my arm, touch my shoulder, or touch my forehead and rock my head during my Rapid Transformational session(s) in order to help facilitate the deepening process.

Confidentiality

By signing this form, I consent that Terry Alexander may release information to a specific individual or agency if it has been determined that a vulnerable person (child or elder) 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, Terry Alexander may discuss aspects of my case with other colleagues keeping my full name and identity completely confidential always unless I have given permission otherwise.

I have accurately and truthfully answered any questions and provided background information during the initial consultation and /or first therapy session and will continue to do so during any subsequent therapy sessions.

Please Note: You can print, sign and send in an email to terry@belimitlesstherapy.com or simply request a copy upon booking. 

Print Name.............................................................................................. 

Signed Name............................................................................................ 

Date...................................................................................................... 

Thank you for your understanding and cooperation. If you have any further questions please contact me.

terry@belimitlesstherapy.com