Liability

I, [your name], hereby release Jin Wen Shen (also known as Natasia) and Natasia Hypnotherapy 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 Jin Wen Shen (also known as Natasia) is not a licensed physician, psychologist, or medical practitioner of any kind and that Rapid Transformational Therapy® and hypnotherapy should not be considered a replacement for the advice and/or services of a psychiatrist, psychologist, psychotherapist, or doctor.

 

Participation

I give Jin Wen Shen (also known as Natasia) at Natasia Hypnotherapy full permission to hypnotize me through in-person sessions or internet meeting sessions and to use Hypnotherapy and Rapid Transformational Therapy® through in-person sessions or internet meeting sessions, 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® and Hypnotherapy have an incredibly high success rate, Jin Wen Shen (also known as Natasia) and Natasia Hypnotherapy cannot and does not guarantee results since my own personal success depends on many factors that Jin Wen Shen (also known as Natasia) and Natasia Hypnotherapy have no control over, including my willingness and desire to effect the changes inside myself.

 

Audio Recording(s)

I give Jin Wen Shen (also known as Natasia) and Natasia Hypnotherapy 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),  Jin Wen Shen (also known as Natasia) and Natasia Hypnotherapy retain full copyright over any forms of media that may be produced and distributed to me. Jin Wen Shen (also known as Natasia) and Natasia Hypnotherapy may also use any audio recordings in published courses, programs, or other forms of media online or offline, excluding my voice, keeping my full name and identity completely confidential always unless I have given permission otherwise. 

​

​

Deepening Process

I hereby grant permission to Jin Wen Shen (also known as Natasia) at Natasia Hypnotherapy to respectfully lift my arm, touch my shoulder, or rock my head during my on site in-person Rapid Transformational Therapy® session(s) and Hypnotherapy session(s) in order to help facilitate the deepening process.


 

Confidentiality

By signing this form, I consent that Jin Wen Shen (also known as Natasia) and Natasia Hypnotherapy 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, Jin Wen Shen (also known as Natasia) at Natasia Hypnotherapy may discuss aspects of my case with other colleagues, or with potential clients, keeping my full name and identity completely confidential always unless I have
given permission otherwise. Jin Wen Shen (also known as Natasia) and Natasia Hypnotherapy may also use my case as case studies or examples in published medias, books, or courses, keeping my full name and identity completely confidential always unless I have given permission otherwise.