Informed Consent & Terms & Conditions
Before proceeding with treatment it is important that you, the "Client" understands the necessary information about the treatment.
This form contains important information about RTT & hypnotherapy, including my terms and conditions. This explains the rights of my clients, the privacy protection, and how I use your personal information.
By completing the Intake form and agreeing to work with me you are agreeing to these terms. Thus, it is important that aside from reading over the contents of the form, you discuss any questions you might have with me before your first session.
What is Hypnotherapy?
Hypnotherapy is a mode of therapy conducted on an individual basis. Treatment using hypnotherapy is done while the client/patient is in a relaxed, trance like state.
Compared to "talk therapy," there is so much that can be accomplished with hypnotherapy in a shorter amount of time. The benefits of hypnotherapy can be imediate, incremental or retroactive.
Sessions and Experience
A typical RTT session takes between 90 minutes to 2 hours. This is done by assisting you to reach a relaxed state that shall induce you to a state of hypnosis. Age regression may be conducted for helping to release behavioral, cognitive, and emotional blockages. Part of the session may include healing and upgrading your inner child this is an empowing part of the therapy and assists in developing a new positive outlook.
Audio Recording(s)
The initial induction and final transformation portions are recorded. You will receive a copy of this audio file following your session for you to listen to everyday, for the following 21 days. This is an important part of the therapy and its success in coding in new beliefs. I will send the file via email or whatsApp to your mobile phone. I cannot guarantee the privacy and security of information sent through this medium.
By signing below you agree to give Samantha Goddard 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) Samantha Goddard retains full copyright over any forms of media that may be produced and distributed to me.
Risks
This therapy is not suitable for those with epilepsy or any form of psychosis. If you continue with this you are accepting full responsibility for taking part in the hypnosis and agreeing Samantha Goddard holds no liability for any potential outcome.
Occasionally hypnotherapy can be an intense process as treatment may bring up unpleasant memories or emotions, but this is helpful for healing. The client is reassured during the session that they are not reliving any unpleasant memories, they are just reviewing, in order to gain new insight and freedom.
Benefits
There are many benefits to hypnotherapy. The hypnotic state allows the patient to be more receptive to discussion and suggestions. Thus, it helps treating phobias, anger, fears, depression, stress, loss and grief, anxiety and eating disorders among other things. It can also be used as a treatment of controling and overcoming addictions and habits. To achieve the ideal results, the full and active cooperation of the patient is required.
Deepening Process
I hereby grant permission to Samantha Goddard to respectfully lift my arm, touch my shoulder, gently tap my forehead or rock my head during my Rapid Transformational session(s) in order to help facilitate the deepening process. In person sessions only.
Liability
I (the client) hereby release the therapist, Samantha Goddard 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 signing this form.
Scope of Practice
I understand that Samantha Goddard is not a licensed physician, psychologist, or medical practitioner of any kind and that hypnosis should not be considered a replacement for the advice and/or services, of a psychiatrist, psychologist, psychotherapist, or doctor.
Participation
I give Samantha Goddard 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, I agree to listen to my recording.
As part of your RTT programme you will also have a 30 minute weekly call with me on Zoom. If you need to cancel or rearrange please give as much notice as possible. If you do not turn up for a call or cancel within 24 hours the call may not be rebooked.
Payment
I agree to pay in full for my therapy and understand refunds are only given within 14 days of completing the Intake Form and before treatment commences. Once treatment has started no refunds are possible.
Permission
I agree to be contacted by Samantha Goddard or her assistant via email, Zoom and phone, including whatsapp and/or by text message. I am happy to receive my personal recording via whatsapp and/or email and being added to her client mailing list. I am aware I can opt out at any time.
Disclaimer
I understand that although Rapid Transformational Therapy has an incredibly high success rate, Samantha Goddard cannot and does not guarantee results since my own personal success depends on many factors that Samantha Goddard has no control over, including my willingness and desire to affect the changes inside of myself.
Confidentiality
By signing this form, I consent that Samantha Goddard may release information to a specific individual or agency if it has been determined that a child or elder is at risk of or is currently being abused; 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, Samantha Goddard may discuss aspects of my case with other colleagues keeping my full name and identity completely confidential always, unless I have given permission otherwise.