Liability

I, (The Client), hereby release Susan Hayward (Hypnotherapist) from any liability or claims that could be made against her concerning my mental and / or physical well-being during the work that is to be agreed upon (now and in the future) by clicking on the checkbox. This liability waiver is not intended to exclude or restrict liability for death or personal injury caused by negligence.

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Scope of Practice

I understand that Susan Hayward 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.

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Participation

I give Susan Hayward full permission to hypnotize me and to use Rapid Transformational Therapy® 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.

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Guarantee

I understand that although Rapid Transformational Therapy® has an incredibly high success rate, Susan Hayward cannot and does not guarantee results since my own personal success depends on many factors that Susan Hayward has no control over, including my willingness and desire to effect the changes inside myself.

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Audio Recording(s)

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

 

Deepening Process

If my RTT session is face-to-face, I hereby grant permission to Susan Hayward to respectfully lift my arm, touch my shoulder or hand, and rock my head during my Rapid Transformational Therapy® session(s) in order to help facilitate the deepening process.

 

Confidentiality

By clicking the checkbox of this form, I consent that Susan Hayward 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, Susan Hayward may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always unless I have given permission otherwise.