Liability Waiver and Informed Consent Agreement
Therapist: Nathalie Crittenden-Lopis
Practice: Your Therapy and Wellbeing (yourtherapyandwellbeing.com)
Client Name: ______________________________________
By signing this agreement, the Client acknowledges and consents to the following terms:
1. Liability Waiver
The Client hereby releases Nathalie Crittenden-Lopis, Your Therapy and Wellbeing (yourtherapyandwellbeing.com), from any liability or claims relating to their mental and/or physical well-being during the course of therapy, as agreed in advance or in future sessions.
This waiver does not exclude or restrict liability for death or personal injury caused by negligence.
2. Scope of Practice
The Client acknowledges that Nathalie Crittenden-Lopis is not a licensed doctor, physician, psychologist, or medical practitioner.
Hypnotherapy and Rapid Transformational Therapy® (RTT®) should not be considered replacements for medical, psychiatric, or psychological care.
Clients are encouraged to seek advice from qualified medical professionals for diagnosis, treatment, or care as appropriate.
3. Participation and Client Responsibility
The Client consents to participate in hypnotherapy and RTT® sessions with Nathalie Crittenden-Lopis.
The Client agrees to actively engage in the process and to listen to their personalised recording for at least 21 consecutive days, understanding that success depends on their participation.
4. Guarantee
The Client understands that while RTT® has a high success rate, no specific results can be guaranteed.
Outcomes depend on personal factors beyond the therapist’s control, including the Client’s willingness and motivation to change.
5. Audio Recordings
The Client grants permission for audio recordings to be made during or after sessions, which may include their voice.
Nathalie Crittenden-Lopis retains full copyright over all recordings and related media, which may be provided to the Client for personal use.
6. Deepening Process (In-Person Sessions Only)
The Client consents to respectful physical facilitation of the hypnotic deepening process, which may include:
Lifting of the arm
Touching of the shoulder
Touching of the forehead
Gentle rocking of the head
7. Confidentiality
All sessions and records are kept confidential, except in the following circumstances:
Where a vulnerable child or adult is at risk.
Where the Client is in imminent danger of harming themselves or others.
Where a court of law issues a subpoena.
The Client understands that aspects of their case may be discussed in professional supervision, with full confidentiality maintained (no disclosure of names or identifying information, unless explicit consent is given or safeguarding requires otherwise).
8. Statement of Consent
By signing this agreement, the Client confirms that:
They have read, understood, and consent to all terms of this waiver and informed consent form.
They accept personal responsibility for their participation and outcomes.
They consent to the use of audio recordings, physical facilitation during sessions (if in person), and limited exceptions to confidentiality as outlined above.
Signatures
Therapist:
Signed: ______________________
Nathalie Crittenden-Lopis Your Therapy and Wellbeing (yourtherapyandwellbeing.com)
Date: ______________________
Client:
Signed: ______________________
Name: ____________________________________
Date: ______________________
Initials (for consent to all terms): _________
