I, (The Client), hereby release Tessa Brock 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 Tessa Brock 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 Tessa Brock full permission to hypnotise me and to use Rapid Transformational Therapy® knowing that by participating fully in the process and by listening to my personalised recording every day, for at least 21 days, starting within 36 hours of the end of the session, I play an important role in my overall success.


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

Audio Recording(s)

I give Tessa Brock full permission to make audio recordings that may include my     voice. I understand that if a recording (or recordings) is made during or after my session(s) Tessa Brock retains full copyright over any forms of media that may be produced  and distributed to me.

Deepening Process

(Only necessary in in-person sessions)

I hereby grant permission to Tessa Brock 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.


I consent that Tessa Brock 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, Tessa Brock may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always unless I have given permission otherwise.