Waiver | Achieve MindCoaching

Mind Coaching Liability Waiver

(Confidentiality will be honoured in all sessions)

First name

Last name

Date of Birth

Do you have a doctor’s pemission to undergo hypnosis for pain management?

Yes

Do you have a doctor’s pemission to undergo hypnosis for weight management?

Yes

Do you have a doctor’s or therapit's pemision to undergo hypnosis for assistanc in dealing with symptoms of depression?

Yes

Please specify any medical conditions or other phenomena that should known about:

Initials

I declare that the info I’ve provided is accurate & complete

I understand that the dialogue of, and any exchange of words between myself and Andrew Slater (the ’Consulting Hypnotist’) during a session are done so in an effort to make improvements to the overall quality of my life and my experience thereof. In addition, I give Andrew Slater my full permission to use assessments, including but not limited to, muscle testing, range of motion (R.O.M) testing, EFT (Emotional Freedom technique), FasterEFT (Faster Emotional Freedom Technique), ’Thought Field Therapy’, and any other assessments that are deemed pertinent in the context of a hypnosis session. By signing this waiver I am exempting Andrew Slater from responsibility for any injuries or medical or emotional trauma that may result from the provision of his services. I acknowledge that by signing this waiver I am giving consent for treatment and that I understand the potential risks involved with the services that are provided. I also acknowledge that by signing this waiver I am agreeing to use the revelations, suggestion, and information gleaned in a session to make powerful and effective change(s) in my life that will yield real benefits for me.

Emergency Contact:

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