LIABILITY
I, The client, hereby release Jackie Shaw from any liability or claims that could be made against (him/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 Jackie Shaw 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 Jackie Shaw 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.
GUARANTEE
I understand that although Rapid Transformational Therapy has an incredibly high success rate, Jackie Shaw cannot and does not guarantee results since my own personal success depends on many factors that Jackie Shaw has no control over, including my willingness and desire to effect the changes inside myself.
AUDIO RECORDING(S)
Jackie Shaw retains full copyright over any forms of media that may be produced and distributed to me.
CONFIDENTIALITY
By signing this form, I consent that Jackie Shaw 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, Jackie Shaw may discuss aspects of my case with other colleagues, keeping my full name and identiy completely confidential always unless I have given permission otherwise.