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I, (The Client) , hereby release Simin Liang from any liability or claims that could be made against (him/her) concerning my mental and/or physical well-being duringthe 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 Simin Liang is not a licensed physician, psychologist, or medical practitioner of any kind and that hypnotherapy should not be considered a replacement for the adviceand/or services of a psychiatrist, psychologist, psychotherapist, or doctor.



I give Simin Liang full permission to hypnotize me and to use Rapid TransformationalTherapy® 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, Simin Liang cannot and does not guarantee results since my own personal successdepends on many factors that Simin Liang has no control over, including my willingness and desire toeffect the changes inside myself.


Audio Recording(s)

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


Deepening Process

I hereby grant permission to Simin Liang to respectfully lift my arm, touch my shoulder, or rock my head during my Rapid Transformational Therapy® session(s) in order to helpfacilitate the deepening process.



By signing this form, I consent that Simin Liang may release information to a specificindividual 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, Simin Liang may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always unless I havegiven permission otherwise.

Thanks for submitting!

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