DISCLAIMER FORM

---

Liability

I hereby release Robert Newsome 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 acknowledging 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 Robert Newsome is not a licensed physician, or medical practitioner of any kind and that Emotion Code, Body Code, Belief Code or hypnotherapy should not be considered a replacement for the advice and/or services of a psychiatrist, or medical doctor.

Participation in Rapid Transformational Therapy®

I give Robert Newsome full permission to hypnotize me and to use Rapid Transformational Therapy® 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.

Guarantee

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

Audio Recording(s)

I understand that by participating in the Rapid Transformational Therapy® process that I will be given a personalized recording to listen to for a minimum of 21 days. I understand that listening to the recording daily plays a significant part in the success of my treatment.

Confidentiality

By acknowledging this form, I consent that Robert Newsome 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, Robert Newsome may discuss aspects of my case with other colleagues, keeping my full name and identity completely confidential always unless I have given permission otherwise.