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Sample Liability Form

Many countries legally require that therapists give you a liability form for you to read and sign before the start of therapy. This is or your protection, so you understand your responsibilities in therapy.

Below is an example of the kind of form your therapist might use. Typically, you will fill this out at his office, or before starting the therapy, say if you are using skype for a session. Your therapist may ask you to download this form and bring it (or email it before therapy begins), or he may have his own form.

Client Liability Agreement
Revision 1.3a, Nov 2009

Intent: The material that you will be learning is state of the art and still very experimental. Long-term effects, if any, have not been studied or researched. Thus, we cannot guarantee that you will not have some sort of adverse reaction that we did not anticipate. If you are not willing to take full and complete responsibility for what happens by using our material, we require that you not start with the workshop or private session. This is all common sense given the nature of our material, but we want to make it perfectly explicit up front.

I (Print name),

 located at the address,

 do agree to the following:

  1. I take complete responsibility for my own emotional and/or physical well being both during and after this workshop or private session.
  2. I agree to hold harmless the person who guides me in the use of the Institute for the Study of Peak States (ISPS) techniques, the ISPS, and anyone associated with the ISPS now, in the past or in the future, from any claims. 
  3. I will only use the techniques under the supervision of a qualified, certified therapist or physician as legally appropriate.
  4. I will not use these techniques by myself to try to solve a problem where common sense would tell me that it is not appropriate.
  5. I agree not to teach these techniques to others. 
  6. I agree not to tape or record any sessions using Gaia commands.
  7. For safety reasons I agree not to disclose these techniques and any Gaia commands to anyone else, including my partner, family, friends, therapists and clients.  
  8. I understand that all ISPS processes are trademarked (such as Whole-Hearted Healing™ and Distant Personality Release™ etc.) and cannot be taught without approval by the Institute just as with any trademark – you can’t sell a soft drink that you make and call it Coca-Cola, for example).

Signed:                                                                         Date:

Revision History
1.0, Sept 1, 2012: First draft of this webpage.