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I, by my own free will, sign this waiver and accept all risks and I am perfectly aware that Valentina Plishchina will be the person conducting the therapy sessions associated with hypnosis. Valentina Plishchina is NOT a licensed Physician, NOR is she a licensed Psychiatrist and she CAN’T diagnose NOR treat any type of physical or mental disorders. I fully understand that these hypnosis sessions are solely for educational and/or emotional enrichment. I also understand that any suggestions made during any session are part of a personal motivational and educational goal and it’s only of informational character. Valentina Plishchina DOES NOT pretend to be a licensed professional in Medicine or in any medical field and she is NOT a Mental Health specialist.
With this document, I waive any claim to personal injury liability that may be the end result of any hypnosis therapy session. I also agree that Valentina Plishchina assumes NO responsibility for the results of this therapy process, NOR does she guarantee its final outcome or effectiveness
I certify that I am a competent adult of legal age and I assume all risks and complete responsibility in the final outcome of this therapy. I am also voluntarily signing this consent form with my full legal name. This waiver and acceptance of risk is effective as of today and it can’t be revoked, altered, modified, annulled or invalidated, without the prior written consent of Valentina Plishchina.
CONSENT TO AUDIO AND/OR VIDEO RECORDINGS
By signing this document, I understand that this, as well as any future therapy sessions will be recorded by audio and/or video means. This is strictly for safety purposes and will also serve as a learning tool. At the end of each session, I understand I will receive a copy of any audio and/or video recordings made and the original recording will become the exclusive property of Valentina Plishchina. These recordings will be held in strict confidentiality, except when the patient DOES NOT want to share the session in an anonymous way to promote the therapy methods developed by Aurelio Mejía (Introspective Hypnosis) Valentina Plishchina will NOT be held responsible and is free of any liability due to damages caused through the unlawful use of any audio and/or video recordings made during of any therapy sessions, if posted or published on the Internet, by the Patient or third parties associated with or related to the Patient.
CONSENT TO THE CONTENTS OF THIS DOCUMENT
By signing this document, I understand that I have carefully read and understand all the clauses of this document and I make the commitment to abide by all its clauses. My signature also means that I will have the opportunity to request clarification of any doubts that I may have about this subject and that I will be provided with answers in a satisfactory manner.
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