***Please note that I will be unable to offer my professional services if you suffer from epilepsy or any form of psychosis.
Liability I, (The Client) hereby release Lisa Corbett 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 Lisa Corbett 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 Lisa Corbett full permission to hypnotize me and to use Rapid Transformational Therapy® knowing that by participating fully in the process and by listening to the recording for minimum of 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, Lisa Corbett cannot and does not guarantee results since my own personal success depends on many factors that Lisa Corbett has no control over, including my willingness and desire to effect the changes inside myself.
Audio Recording(s) I give Lisa Corbett 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) Lisa Corbett retains full copyright over any forms of media that may be produced and distributed to me. Deepening Process I hereby grant permission to Lisa Corbett to respectfully lift my arm, touch my shoulder, or rock my head during my Rapid Transformational Therapy® session(s) in order to help facilitate the deepening process while in person.
Confidentiality By agreeing this form, I consent that Lisa Corbett 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, Lisa Corbett may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always unless I have given permission otherwise. This includes working in a group setting.
CLIENT TERMS AND CONDITIONS Please read these terms and conditions which apply to the provision of my professional services. By making an appointment or attending a group setting, you are agreeing to the following terms and conditions. If you are unable or unwilling to agree to these terms and conditions, then you should not book an appointment, participate in group sessions or continue with your course of therapy.
FREE INITIAL CONSULTATION You may be offered a free 20-30 minute online initial consultation. No therapy will be provided during the consultation. The purpose of this initial consultation is to discuss the presenting issue. During these calls, estimates of the number of sessions required to deal with your presenting issue are given on the basis of the information presented at that time. Estimates are only rough guidelines and are subject to change. If you are receiving care or treatment from any medical, healthcare or therapy practitioner, e.g. GP, Psychologist, Psychiatrist or Counsellor, you may be asked to seek their permission before any therapy sessions can commence.
***Please note that I will be unable to offer my professional services if you suffer from epilepsy or any form of psychosis.
AGE RESTRICTIONS You must be at least 18 years old to participate in online sessions. Clients under the age of 18 years old must be accompanied by a parent or guardian and will be seen in-person
HYPNOTHERAPY RECORDINGS Hypnotherapy recordings should not be listened to whilst driving, operating machinery or undertaking any other activity where concentration is required. Any recording provided is for your personal use only and must not be shared, lent, copied or sold under any circumstances.
OUTCOME OF SESSIONS The agreement to work on the issues presented by you in no way implies or guarantees the resolution of your presenting issue(s). No outcome can or will be guaranteed. However, I will always endeavour to use my best efforts and skills to work towards your goals and intended outcomes.
STANDARDS OF BEHAVIOUR During the course of any sessions, I will treat you with respect and not abuse the trust you place in me. I will use best practice at all times in our mutual interest. In return, you undertake not to harm yourself, or any other person, including me, or any property belonging to either me or any other person. You agree not to attend sessions under the influence of alcohol or recreational drugs, except those medications which have been prescribed by your doctor. If you do attend any sessions under the influence of alcohol or recreational drugs, or demonstrate violent or abusive behaviour, I will cancel the session and may refuse to see you for any further sessions.
CONFIDENTIALITY All contact, including sessions, telephone conversations and emails, will be conducted in confidence and may be recorded. Prior to any recording, your agreement will be sought. All recordings, conversations and notes will remain confidential, except in the following circumstances:
1. Where you give permission for confidentiality to be broken
2. Where I am compelled by a court of law
3. Where the information is of a nature that confidentiality cannot be maintained, for example:
4. The possibility of harm to yourself or others exists
5. In cases of fraud or crime
6. When minors (under 18 years old) are involved
7. Where a referring GP or other healthcare professional requires a report. A copy of the report will be available on request.
LIABILITY & INDEMNITY Under no circumstances will Lisa Corbett be liable for any damages, including without limitation, direct, indirect, incidental, special, punitive, consequential, or other damages (including without limitation lost profits, lost revenues, or similar economic loss), whether in contract, tort, or otherwise, arising out of the advice or information provided to you during professional services provided by Lisa Corbett. In addition, you agree to defend, indemnify, and hold Lisa Corbett harmless from and against any and all claims, losses, liabilities, damages and expenses (including legal fees) arising out of your participation in the professional services.
GOVERNING LAW These terms and conditions and any other matters arising out of or in relation to these terms, shall be governed by and construed in accordance with the laws of Scotland, England and Wales. You agree to submit to the exclusive jurisdiction of the Scottish courts to settle any dispute which may arise out of or in connection with these terms and conditions.
TERMS AND CONDITIONS UPDATES These terms and conditions are subject to revisions without notice. Please familiarise yourself with any amendments if you have re-started therapy with me after a long period of absence.
DATA PROTECTION For my services, your personal data is collected, processed, used and stored in accordance with the privacy policy: please also refer to my CLIENT PRIVACY STATEMENT found on my website @ www.nothingbutloveandtherapy.co.uk
By booking an appointment/ group session, you signify your acceptance of this Privacy Policy. If you do not agree to this policy, please do not book an appointment, or attend any group sessions. The terms of this Privacy Policy may change from time to time without prior notice to you, so please check my booking link periodically for any changes. CONCERNS & COMPLAINTS If you have a concern or complaint regarding your therapy, please discuss this with myself in the first instance and I will endeavour to resolve the issue.
STATEMENTS OF UNDERSTANDING By attending and participating with the group sessions, you agree to abide by the terms and conditions of the Client Agreement. You also agree with the statements below: I confirm that I have been advised by Lisa Corbett of the scope of the therapies that she provides and give my full consent to receiving therapy / Group sessions from Lisa Corbett I understand that results may vary from person to person and the agreement by Lisa Corbett to work on the issues or problems presented by me, using whatever therapies are appropriate to my situation, in no way implies or guarantees the resolution of any presenting problems or issues. I understand that hypnotherapy or any other therapy or information provided by Lisa Corbett either in person or via telephone, email or online (internet), is not a replacement or substitute for medical, psychological or psychiatric treatment. If I have any doubts or concerns about my health, I will seek advice from an appropriate qualified healthcare professional. I declare that, if advised by Lisa Corbett prior to or following any therapy / Group sessions, to seek medical approval, I will consult with my GP, hospital consultant and/or other healthcare professional and gain the appropriate written approval for Lisa Corbett prior to the next therapy session. I have been advised that I am free to terminate any or all sessions at any time. I understand that my level of motivation is vital in the therapy process, and I agree to participate to the best of my ability at all times, including making reasonable use of therapeutic suggestions during and between sessions, as well as listening to MP3 recordings and/or carrying out other therapeutic tasks as appropriate. I have accurately and truthfully answered any questions and provided background information during the initial consultation and /or first therapy session (If required) and will continue to do so during any subsequent therapy sessions.
CONFIDENTIALITY I consent that Lisa Corbett 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, Lisa Corbett 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 PRIVACY STATEMENT This is to inform you what data I am collecting from you and what I intend to do with it. What data do I keep and why do I need it? Name and age – this is basic information that helps me get to know you. Address, email address, phone number – I use this as a way of contacting you regarding your sessions. I will mainly use the method you first contacted me on but if I cannot reach you, I will try a different method. Next of kin/medical professional’s details – If I was worried that you were at risk then I may need to contact your next of kin or medical professional, if I can. I will let you know when/if I am going to do this. Session notes – I keep brief notes of our session(s), [Digital form and password protected, any paperwork is filled in a secure cabinet]
Will I share your data and if I do, who will I share it with and for what purpose? It is very unlikely that I will share your data. I will not sell it on or use it for unethical reasons. I may have to share it if my notes are subpoenaed by court, if you or anyone you tell me about is at harm or risk of harm, I may have to pass this information on. I may also discuss your case during supervision, but I only use your first name. How will I store your data? Example text: It is mainly stored as hard copy in a locked filing cabinet. Immediately after the work is finished, I transfer the data with your initials to my password protected computer. Your phone number(s) may be kept in my business mobile phone and be pin protected. Only I will access your information.
How long will I store your data for and how will I dispose of it? I will keep your details and session notes for the time required by my insurer (currently 7). After this time, I will destroy any document with your personal information and delete your phone number out of my mobile phone. CLIENT CONSENT By being in this group I agree to the terms and conditions set out above. I confirm i am happy with terms and date use set out in this DISCLAIMER.