Liability

I, (The Client), hereby release, RuLeecia Rohbock, 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 RuLeecia Rohbock, 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, RuLeecia Rohbock, 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, RuLeecia Rohbock, cannot and does not guarantee results since my own personal success     depends on many factors that, RuLeecia Rohbock, has no control over, including my willingness and desire to effect the changes inside myself.

Audio Recording(s)

I give, RuLeecia Rohbock, 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), RuLeecia Rohbock, retains full copyright over any forms of media that may be produced and distributed to me.

Deepening Process

I hereby grant permission to, RuLeecia Rohbock, 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. (Only for In-person sessions.) 

Confidentiality

By autographing this form, I consent that, RuLeecia Rohbock, 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, RuLeecia Rohbock, may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always, unless I have given permission otherwise.

Consent

When you check the box on the landing page, and place your autograph in the box, you are agreeing to this Disclaimer Form.