Complete & submit at least 24 hours before our session
I the client, hereby release Christina Michelle Patterson (the hypnotist) 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.
SCOPE OF PRACTICE
I understand that Christina Michelle Patterson 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.
I give Christina Michelle Patterson 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 understand that although Rapid Transformational Therapy has an incredibly high success rate, Christina Michelle Patterson cannot and does not guarantee results since my own
personal success depends on many factors that Christina Michelle Patterson has no control over, including my willingness and desire to affect the changes inside of myself.
I give Christina Michelle Patterson 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) Christina Michelle Patterson retains full copyright over any forms of media that may be produced and distributed to me.
I hereby grant permission to Christina Michelle Patterson to respectfully lift my arm, touch my shoulder, or rock my head during my Rapid Transformational session(s) in order to
help facilitate the deepening process. Does not apply to long distance sessions.
By electronically signing this form,I consent that Christina Michelle Patterson 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, Christina Michelle Patterson may discuss aspects of my case with other colleagues keeping my full name and identity completely confidential always unless I have given permission otherwise.