The following should be read and understood before signing.

This form contains important information about Rapid Transformational Therapy® and Accelerate Wellness Hypnotherapy LLC, including important terms and conditions, the rights of you, the "Client,” my privacy protection policy and the use of your personal information. By completing this Consent Form and agreeing to work with me you are agreeing to these terms and conditions. Please read this Informed Consent, Terms and Conditions form (Agreement) carefully and discuss any questions you might have with me before your first session. I, hereby consent to participate in Accelerate Wellness Hypnotherapy LLC with my certified Hypnotherapist and Rapid Transformational Therapy® trained Practitioner and that by signing this document, I am agreeing to be a client in an RTT® session delivered by online delivery via technology assisted media or other electronic means. I understand that the live online delivery means the RTT® practitioner and client are located in two different locations.  I understand the following with respect to Rapid Transformational Therapy® and Accelerate Wellness Hypnotherapy LLC: What is Rapid Transformational Therapy® Rapid Transformational Therapy integrates hypnosis and elements of neurolinguistic programming, cognitive behavior therapy, and psychotherapy in a science-based approach designed to more quickly promote growth, healing and lasting change than traditional talk therapy alone. It is a relaxing, proven method of accessing the inner mind to help recognize and change limiting beliefs. Once old, negative and fear-based thoughts are identified, a healing journey of positive change can begin. Accelerate Wellness Hypnotherapy LLC Sessions and Experience Sessions are personalized to address your needs, upgrading behaviors and beliefs deeply rooted in past events that may be blocked or forgotten. Age regression (guiding a client back in time under hypnosis to relive a past event) may be conducted to identify and intentionally reframe these events, allowing you to create new more beneficial meanings and positive habits of thought. These are then reinforced through focused recordings that you can carry with you and listen toas you deepen the new neural pathways. The typical RTT® session takes between 90 minutes to 2 hours. As an Accelerate Wellness Hypnotherapy LLC client in an RTT® session you may be asked to raise and lower your arm(s), touch your shoulder(s), gently tap your forehead or rock your head in order to help deepen the hypnosis. If there is any reason you should not participate in these activities please let your Rapid Transformational Therapy® trained Practitioner know and do not move forward with the activity. Certain activities may be modified for you. By signing this form you agree that you are able to participate in such activities. Audio Recording(s)Your Accelerate Wellness Hypnotherapy LLC session is designed to include a focused transformational recording created just for you. We will provide you with a copy of this audio file following your session for you to listen to every day for the following 21 days. We may send such files via email, messaging app, or by sharing a link on how you can download the file. Please note that we cannot guarantee the privacy and security of the information sent through this medium. RTT® Hypnotherapy recordings should not be listened to when concentration is required such as driving a vehicle or operating machinery. By signing below you agree to give ​Accelerate Wellness Hypnotherapy LLC permission to make audio recordings that may include your voice. You also acknowledge that if a recording or recordings are created during or after my session(s), recordings are for personal use only Accelerate Wellness Hypnotherapy ​LLC retains the full copyright over all forms of media that may be produced and distributed to me. I agree not to copy, share or sell these recordings.   Potential Risks Accelerate Wellness Hypnotherapy LLC and RTT® are not suitable for and Accelerate Wellness Hypnotherapy LLC will not be able to offer RTT® Hypnotherapy to those with epilepsy, those having suicidal or homicidal thoughts, those actively experiencing psychotic symptoms or any form of psychosis or experiencing a mental health crisis. If you believe you are experiencing a medical or mental health emergency please call 911 or your local medical emergency number or seek immediate care from the nearest hospital emergency room. By continuing you are accepting full responsibility for taking part as an Accelerate Wellness Hypnotherapy LLC client in an RTT® session that includes hypnotherapy delivered in person or by online delivery via technology assisted media or other electronic means RTT® and agreeing Accelerate Wellness Hypnotherapy LLC holds no liability for any potential outcome. Hypnotherapy and regression can be an intense process as it may bring to mind unpleasant memories or emotions. This is viewed as helpful for healing. During the session the client is reassured that they are not reliving the unpleasant memories but merely reviewing them in order to reframe them and create new more beneficial meanings and positive habits of thought.  We cannot guarantee that hypnotherapy works for everyone or happens at the same pace as others. While designed to more quickly promote growth, healing and lasting change, results vary. You are solely responsible for creating and implementing any direct or indirect result of any services provided by Accelerate Wellness Hypnotherapy LLC and the RTT® Practitioner. I understand that Accelerate Wellness Hypnotherapy LLC and RTT® do not prevent, cure, or treat any mental disorder or medical disease. Potential Benefits Rapid Transformational Therapy integrates hypnosis and elements of neurolinguistic programming, cognitive behavior therapy, and psychotherapy in a science-based approach designed to more quickly promote growth, healing and lasting change than traditional talk therapy alone. It is a relaxing, proven method of accessing the inner mind to help recognize and change limiting beliefs. I acknowledge that my active participation in the RTT® process and listening to my personalized recording for 21 days is important for my overall results. I agree to communicate honestly and create the time and energy to participate fully in the session(s). Limited Liability Except as expressly provided in this Informed Consent, Terms and Conditions form (Agreement), Accelerate Wellness Hypnotherapy LLC makes no guarantees, representations or warranties of any kind or nature, express or implied with respect to the services negotiated, agreed upon and rendered. In no event shall Accelerate Wellness Hypnotherapy LLC or the Accelerate Wellness Hypnotherapy LLC certified Hypnotherapist/Rapid Transformational Therapy® trained Practitioner be liable to the Client for any indirect, consequential or special damages. Notwithstanding any damages that the Client may incur, the Accelerate Wellness Hypnotherapy LLC and the Accelerate Wellness Hypnotherapy LLC certified Hypnotherapist/Rapid Transformational Therapy® trained Practitioner’s entire liability under this Agreement, and the Client’s exclusive remedy, shall be limited to the amount actually paid by the Client to Accelerate Wellness Hypnotherapy LLC under this Agreement for all Hypnotherapy and RTT® services rendered through and including the termination date. Scope of Practice I understand and agree that an Accelerate Wellness Hypnotherapy LLC certified Hypnotherapist/Rapid Transformational Therapy® trained Practitioner is not licensed or trained as a doctor, therapist, psychologist, or any other similar professional. I also acknowledge that the Accelerate Wellness Hypnotherapy LLC certified Hypnotherapist/Rapid Transformational Therapy® trained Practitioner has not offered, attempted, or promised to provide me with any services that require a professional license, and that an Accelerate Wellness Hypnotherapy LLC certified Hypnotherapist/Rapid Transformational Therapy® trained Practitioner is not permitted, authorized, or expected to do so. Accelerate Wellness Hypnotherapy LLC certified Hypnotherapy and Rapid Transformational Therapy® are never intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical or psychological condition. Never disregard professional medical advice or delay in seeking it because of something you have read, heard or experienced on this Website or from an Accelerate Wellness Hypnotherapy LLC certified Hypnotherapist/Rapid Transformational Therapy® trained Practitioner. Free Initial Consultation Accelerate Wellness Hypnotherapy LLC generally offers a free initial consultation by online delivery via technology assisted media or other electronic means to discuss how we might best help and support your needs and goals. During this session, we may ask questions about your medical history to help us assess the appropriateness of Accelerate Wellness Hypnotherapy LLC services and if you are receiving care or treatment from a doctor, therapist, psychologist, or any other similar professional, we may ask for current documentation of their approval to receive Accelerate Wellness Hypnotherapy LLC services. We will also address your questions about RTT® and what you can expect from a session. Please note that RTT® Hypnotherapy or other services will not be provided during the free consultation. Schedule and Fees By signing this form, I agree to pay Accelerate Wellness Hypnotherapy LLC in full for my Accelerate Wellness Hypnotherapy LLC session. Accelerate Wellness Hypnotherapy LLC sessions are scheduled in advance and are reserved exclusively for our clients. We require at least twenty-four (24) hours advance notice for rescheduling or canceling an appointment. I acknowledge that once treatment has started no refunds are possible. Please contact us at least 24-hours in advance if you have toreschedule.24-hourCancellation Policy and Fees for Late Cancellations. It is the client’s responsibility to attend all scheduled Accelerate Wellness Hypnotherapy LLC appointments, whether or not you receive a reminder message by phone or email if you have given consent to do so. It is your responsibility to inform Accelerate Wellness Hypnotherapy LLC if your phone number or email has changed. Anytime you reschedule a session without giving 24-hour prior notice of cancellation, you will be charged a $50 late rescheduling fee for rescheduling the session. The credit card information or other payment information you previously provided will be used to process this payment. By providing us with your credit card information or booking an appointment, you consent to this policy. Please note that after 2 consecutive cancellations or no shows you will not be rescheduled for another appointment and will be referred to another provider. Fees For No-Shows Please arrive on time for your appointments. If you are more than 10 minutes late to your appointment, Accelerate Wellness Hypnotherapy LLC will reschedule your appointment and you will be responsible for the $50 late rescheduling fee. Accelerate Wellness Hypnotherapy LLC reserves the right to bill the Client for a missed session. The credit card information or other payment information you previously provided will be used to process this payment. By providing us with your credit card information or booking an appointment, you consent to this policy. Termination Either the client or Accelerate Wellness Hypnotherapy LLC may terminate this Agreement at any time with one week written notice. The client agrees to compensate Accelerate Wellness Hypnotherapy LLC for all services rendered through and including the effective date of termination of the client relationship. Online Delivery I understand that there are risks and consequences associated with an RTT® session delivered online via technology assisted media or other electronic means, including but not limited to disruption of transmission by technology failure, interruption and/or breaches of confidentiality by unauthorized persons, and/or the limited ability to respond to emergencies. I understand that during a an RTT® session delivered online via technology assisted media or other electronic means, we could encounter technical difficulties resulting in service interruptions. If this occurs, please end and restart the session using the link provided. If we are unable to reconnect within ten minutes, please contact us by email or by calling 928 273 1883 to discuss options since we may have to re-schedule. Confidentiality Accelerate Wellness Hypnotherapy LLC values privacy. Information shall be divulged when required by law or when authorized by you.  By signing this form, I acknowledge and consent that Accelerate Wellness Hypnotherapy LLC may release information to specific individuals or agencies if it has been determined that a child, vulnerable adult or elder is at risk of or is currently being abused or if you, as a client, are deemed in imminent danger to yourself or others or if a subpoena for records has been received.  I also understand and consent that ​my Accelerate Wellness Hypnotherapy LLC certified Hypnotherapist/Rapid Transformational Therapy® trained Practitioner ​may discuss aspects of my case with other professional colleagues and will keep my full name and identity completely confidential at all times unless I have given permission otherwise. Data Retention and Record Retention Policy. We only retain your personal data for as long as necessary to fulfill the purposes we collected it for, including for the purposes of satisfying any legal, accounting, or reporting requirements. When choosing the correct time to keep data we look at the amount, nature and sensitivity, potential risk of harm from unauthorized use or disclosure, the processing purposes and if these can be achieved by other means, and legal requirements. For tax purposes and as the law requires, we may keep basic information about Accelerate Wellness Hypnotherapy LLC customers (including Contact, Identity, Financial and Transaction Data) for six years after they stop being Accelerate Wellness Hypnotherapy LLC customers. In some circumstances we may anonymize your personal data for research or statistical purposes in which case we may use this information indefinitely without further notice to you. I acknowledge that Accelerate Wellness Hypnotherapy LLC has disclosed this record retention policy with respect to documents, information and data acquired or shared during the term of the client relationship. Accelerate Wellness Hypnotherapy LLC Services By signing this form, I agree to engage as an Accelerate Wellness Hypnotherapy LLC client and be hypnotized in an RTT® Hypnotherapy session delivered online via technology assisted media or other electronic means. I agree to be contacted by Accelerate Wellness Hypnotherapy LLC via email, telephone by online delivery via technology assisted media or other electronic means, messaging app, and/or by text message. I agree to receive my personal recording via email, messaging app, or by a link on how I can download the file. I agree to listen to my recording. I also agree to being added to the Accelerate Wellness Hypnotherapy LLC client mailing list. I am aware I can opt out at any time. 1. Entirety of Agreement: This document reflects the entire agreement between Accelerate Wellness Hypnotherapy LLC and the Client, and reflects a complete understanding of the parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered or supplemented except in writing signed by both Accelerate Wellness Hypnotherapy LLC and the Client. 2. Dispute Resolution: If a dispute arises out of this agreement that cannot be resolved by mutual consent, the Client and Accelerate Wellness Hypnotherapy LLC agree to attempt to mediate in good faith for up to 30 days after notice given. If the dispute is not so resolved, and in the event of legal action, the prevailing party shall be entitled to recover attorney’s fees and court costs from the other party. 3. Severability If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited. 4. Waiver: The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Agreement. 5. Applicable Law This Agreement shall be governed and construed in accordance with the laws of the State of Arizona without giving effect to any conflicts of laws provisions. 6. Binding Effect: This Agreement shall be binding upon the parties hereto and their respective successors and permissible assigns. By signing you are agreeing to these terms.  I acknowledge that I have read and understand the above information. I have had the opportunity to ask questions regarding the RTT® Hypnotherapy and the information contained in this Informed Consent, Terms and Conditions form (Agreement) and that all of my questions have been answered to my satisfaction.