Transforming with Jasmine
I,................................, hereby release Yasmina Nagnoug Mejai 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 Yasmina Nagnoug Mejai 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 understand that there is a small percentage of a very few number of people (less than 5% of the population) where hypnosis may not work and will not hold Yasmina Nagnoug Mejai accountable if I happened to be in that small percentage.
I give Yasmina Nagnoug Mejai full permission to hypnotize me and to use rapid Transformational Therapy® and/or rapid Transformational Coaching methods, knowing that by participating fully in the process and by listening to my personalized recording for at least 21 days, I play an important role in my overall success.
I also commit to do my best to follow through on the post-sessions selfcare advice given by Yasmina Nagnoug Mejai (such as good nutrition, enough rest and sleep, and avoiding triggering situations and toxic substances or environments) to allow my brain’s neurology and my nervous system to rewire, and to allow my system to start detoxing from habitual subconscious stress hormones to calming chemicals and hormones.
I understand that although rapid Transformational Therapy® and rapid Transformational Coaching have both an incredibly high success rate, Yasmina Nagnoug Mejai cannot and does not guarantee results since my own personal success depends on many factors that Yasmina Nagnoug Mejai has no control over, including my willingness and desire to effect the changes inside myself.
I give Yasmina Nagnoug Mejai full permission to make audio recordings that may include my voice. I understand that if Yasmina Nagnoug Mejai makes a recording (or recordings) during or after my session(s), she retains full copyright over any forms of media that may be produced and distributed to me. Plagiarism is the use of ideas and materials of someone else’s without their consent. This includes all therapeutic tools, and methods used by Yasmina Nagnoug Mejai, as well as all the materials she has transmitted to me, both verbally and in writing. By signing this form, I commit in not copying Yasmina Nagnoug Mejai’s ideas, methods, and materials in any shape or form.
Deepening Process during in person sessions
I hereby grant permission to Yasmina Nagnoug Mejai to respectfully lift my arm, touch my shoulder, or rock my head during my rapid Transformational Therapy® session(s) in order to help facilitate the deepening process.
By signing this form, I consent that Yasmina Nagnoug Mejai 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, Yasmina Nagnoug Mejai may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always unless I have given permission otherwise.