As the Client, I hereby release Michelle Coxill 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 the client agreement form.

 

I understand that Michelle Coxill 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.

 

I give Michelle Coxill 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 a key role in my overall success.

 

I understand that although Rapid Transformational Therapy® has an incredibly high success rate, Michelle Coxill cannot and does not guarantee results since my own personal success depends on many factors that Michelle Coxill has no control over, including my willingness and desire to affect the changes inside of myself.

 

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

 

For in-person sessions, I hereby grant permission to Michelle Coxill to respectfully lift my arm, touch my shoulder, or rock my head during my Rapid Transformational session(s) to help facilitate the deepening process.

  

By signing the Client Agreement, I consent that Michelle Coxill may release information to a specific individual or agency if it has
been determined that a vulnerable person (child or elder) 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, Michelle Coxill may discuss aspects of my case with other colleagues keeping my full
name and identity completely confidential always unless I have given permission otherwise.

 

By signing the Client Agreement, you agree to the Disclaimer above.   Client Agreement is attached to the intake form which will be sent to the client after the initial consultation.