By agreeing to a hypnotherapy session, you agree to the terms below. Also provided via email and in the intake form.
Hypnotherapy Waiver Form
I, (The Client) _______________, hereby release Mayra Leen (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 Mayra Leen 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 Mayra Leen 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, Mayra Leen cannot and does not guarantee results since my own personal success depends on many factors that Mayra Leen has no control over, including my willingness and desire to affect the changes inside of myself.
Audio or Video Recording(s)
I give Mayra Leen full permission to make audio recordings that may include my voice. In the event of group sessions, I give Mayra Leen full permission to record the session that may include my face and name knowing I have the liberty to have my video off or on and change my display name. I understand that if a recording (or recordings) are made during or after my session(s) Mayra Leen retains full copyright over any forms of media that may be produced and distributed to me.
I hereby grant permission to Mayra Leen 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. This is not applicable for virtual sessions.
By signing this form, I consent that Mayra Leen 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, Mayra Leen may discuss aspects of my case with other colleagues keeping my full name. Identity completely confidential always unless I have given permission otherwise.
Cancellation Fees and Refunds
Situations may arise in which you must cancel your appointment. We kindly request that if you do cancel or reschedule the appointment, you do so as soon as practical, and at the least, with a twenty-four hour notice. This will also enable for another person who is waiting for an appointment to be scheduled in that appointment slot.
Refund Policy – One-on-One or Group Sessions
The consultation fee is 100% refundable if you cancel your appointment more than twenty-four hours prior to your appointment time. You may cancel for any reason. Upon request, your credit card will be credited the amount of the consultation fee that that you paid to schedule the consultation.
If you choose to cancel your appointment less than twenty-four hours of your appointment time, you will be assessed a cancellation fee equal to 50% of your consultation fee. There are no refunds after the session.