Expert Outcomes
Stephanie C. Shipper
(919)620-6564
Disclosure and Disclaimer Waiver
For Professional NLP Services
- I fully understand that the attending therapist is not an allopathic doctor (M.D.), psychologist, M.S.W., but is a Certified NLP Trainer and Certified Hypnotherapist. .
- I fully understand the difference between the practice of allopathic medicine and alternative therapies .
- I fully understand that the services provided by the attending therapist are not allopathic, but are behavioral and serve as life coaching.
- I fully understand that the attending therapist performs their service within the parameters of a natural health care and wellness system using NLP and Hypnosis.
- I fully understand that the attending therapist does not offer allopathic drugs or hospitalization. I understand that illness is not being diagnosed nor treated medically, and that the sole intent of treatment offered is for spiritual healing and positive life direction.
- I have solicited the attending therapist’s services in good faith, exercising my free will and following the dictates of my own conscience, which allows me to select what I understand, is most beneficial to my health. Should I be uncomfortable with any advice or suggestions offered, I am free to refuse such direction or advice.
- I understand that it is common to experience fatigue, and /or greater need to rest after treatment. It is sometimes common to experience a full range of emotions in the days after treatment. I agree to set aside the time to allow rest and assimilation of my experience.
- If I desire any services not provided by the attending therapist, which is my prerogative, I fully understand that I could seek them elsewhere.
- I presently seek counsel, advice, opinions, NLP, or points of view and/or programs within the scope of the attending therapist’s wellness and stress reduction practice.
- I fully understand that the services provided by the attending therapist are not generally accepted and/or recommended by allopathic doctors or other conventional health professionals.
- I hereby release the NLP therapist to do NLP tests and therapies and therapies.
Client Signature: ________________________________ Date:__________________________
Name: ____________________________________________________________________________
Address: ________________________________________________
County ____________________
City:__________________________________ State: ___________________ Zip: ____________
Phone: (H) ____________________________ (email):_________________________________
Date of Birth: (mm/dd/yyyy) ___________________________Gender: M: _______F: __________
City/State of Birth: _____________________________
Country of birth: ________________
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