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By purchasing this programme, you hereby release Roshina Khan 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 filling out this form.

Scope of Practice

I understand that Roshina Khan is not a licensed physician, psychologist, or medical practitioner of any kind and that hypnotherapy should not be considered a replacement for the advice and/or services, of a psychiatrist, psychologist, psychotherapist, or doctor.


I give Roshina Khan full permission to hypnotize me, coach 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.


I understand that although Coaching, Hypnotherapy and  Rapid Transformational Therapy®,  has an incredibly high success rate, Roshina Khan cannot and does not guarantee results since my own personal success depends on many factors that Roshina Khan  has no control over, including my willingness and desire to affect the changes inside of myself.


Audio Recording(s)

I give Roshina Khan full permission to make audio recordings that may include my voice. I understand that if a recording (or recordings) are made during or after my session(s) Roshina Khan retains full copyright over any forms of media that may be produced and distributed to me.

Deepening Process

I hereby grant permission to Roshina Khan to respectfully lift my arm, touch my shoulder, or rock my head during my Hypnotherapy, Coaching and Rapid Transformational session(s) in order to help facilitate the deepening process.


By signing this form, I consent that Roshina Khan may release information to a specific individual or agency if it has been determined that a vulnerable person (child or elder) 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, Roshina Khan may discuss aspects of my case with other colleagues keeping my full name and identity completely confidential always unless I have given permission otherwise.



By purchasing this course you accept that no refunds will be given for any course. 

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