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CLIENT: Before we begin, please read this agreement and then sign and date it. This will let us know that you have read and that you understand what is written here. It also covers some of the issues of law governing our relationship. Please bring this form to your first appointment. Please note, these techniques are ‘DO WITH’ techniques, not ‘DO TO’ techniques. If you wish somebody to do all the work for you, then NLP, Timeline Therapy, QCPTM and Hypnosis will not work for you. You must be prepared to change, want to change and put 100% into all the interventions and tasks in order to get the full benefit from these sessions.

1. Qualification: Nicole Weston (the practitioner) has been trained and certified in Time Line

Therapy®, Neuro Linguistic Programming (NLP) and Hypnosis at the Master Practitioner level

and will be using all of these techniques in the Personal Breakthrough and/or coaching sessions. The person you will be working with is not licensed. That means she is not a Medical Doctor, psychiatrist, psychologist, M.F.C.C, and you acknowledge that you have never worked with a licensed person on this problem. (If you have, you need to present us a letter of referral from them before we start therapy. If you have been prescribed medication to take by them, you need to present us a letter of consent from them before we start therapy. (This means a short written note stating that you have informed your health care provider of your decision to engage in Time Line TherapyTM techniques.) Furthermore, nothing that happens here in therapy should be construed as, nor should you believe that it is a substitute for the advice of a licensed person.

2. What to Expect: Your alternative health care practitioner has been trained and certified in

Time Line TherapyTM at the Master Practitioner level and will be doing this technique along with Neuro Linguistic Programming (NLP), The Quantum Change ProcessTM and Hypnosis. The therapy will probably be different from what you might have expected. In total, we will not spend a lot of time talking about the problem, just gathering information about it. In fact, most of the session(s) are about other things.

It is very important for us to discover the internal thought process of HOW you create the

problem. That means that we are looking for your strategy, or how you structure the problem. Because our focus is on structure, that means that, once we discover it, we can move on and focus on having the problem disappear very quickly.

Because of this, your Time Line Therapy® Master Practitioner may cut short your answers or even talk about your problems in ways that you have never considered. She may even ask you questions that you do not totally understand consciously in order for your Unconscious Mind to make the changes you want at the unconscious level. It is important to do this so that we can reduce the time taken for the therapeutic process.

If you have been in a therapy session before, expect that this one will be very different, and quite a bit shorter.

3. The Process: We begin with you telling us the problem. We will ask you for examples of the problem and other questions to discover HOW you do it in your head. We will also probe to discover the source of the problem – the precipitating event(s). Sometime before the end of this part of the session we will ask you what has to happen so that you will know the problem is gone.

4. After the Session: We will probably assign you some very specific tasks to do. If assigned,

these tasks are a fundamental part of the therapy. They may take several days or weeks to

complete. The tasks are directly related to the circumstances that created the problem. YOU

MUST DO THEM. If you do not, then neither you nor we can predict the outcome. Certainly, any guarantees will not be valid if you do not do the tasking.

The second thing that is important is that you will need to stubbornly focus on what you

want. The people who are the happiest over-all in life are those who recognize that you have a choice to focus on what you don't want or what you do want. You can focus on negative

emotions and things that make you feel bad, or you can focus on positive emotions and things that make you feel good. It is your choice. After the session, YOU MUST FOCUS ON WHAT YOU WANT.

5. This is Alternative or Complementary Health Care and Therapy: Your Time Line TherapyTM Master Practitioner is a legal Complementary Healthcare Provider, and not a licensed Medical Doctor, Psychologist, Psychiatrist, Master’s in Family and Child Counseling (MFCC). The services you receive are not licensed in this province or state, nor are they regulated by a governmental body. The self–regulated holistic treatments and client-centered disciplines in which your practitioner is trained and in which he/she has experience include consulting and coaching, Time Line TherapyTM techniques, Neuro Linguistic Programming (NLP), Hypnosis. We will always provide only those services in which we have been trained, and if we find that we cannot help you, we will refer you to a licensed person who can assist you.

During your therapy session we will use one or more of the following techniques:


a. Quantum Time Release techniques: The techniques are a process of active imagination where the client imagines floating above his/her Time Line and letting go of his/her negative emotions and/or limiting decisions (or limiting beliefs). Then the client is also asked to imagine creating events in his/her future that support his/her goals or outcomes. Time Line Therapy® techniques have demonstrated results in a broad variety of presenting problems. It is a powerful technique which allows clients to make long-lasting changes in a very rapid way. Your practitioner is certified as a Time Line Therapy® Master Practitioner by the Time Line Therapy® Association.

b. Evolved Neuro Linguistic Programming (ENLP): NLP is a model of communication (how we communicate to self and others) and how that communication creates and affects our behaviour. As a study, it is a synthesis of cognitive and behavioural philosophies which focus on the information coming in through the neurology (cognitive) and the programs we run inside our heads to produce the behaviours (behavioural) we display. Your practitioner is certified as an NLP Master Practitioner by the American Board of Neuro Linguistic Programming.

c. Hypnosis: All hypnosis is self-hypnosis and your practitioner will always ask permission. This is the use of trance to make changes at the unconscious level. Hypnosis has been used to produce unconscious change with clients since 1843. The practitioner is certified as a Hypnotherapist by the American Board of Hypnotherapy. Since Hypnosis may be used during your session, for your safety you should make sure that you are totally wide awake before driving or doing any other activity that may require concentration.

d. The Quantum Change Process™: The use of muscle testing to uncover the root issue and the details required to clear that issue. You will be made aware of old patterns and the deeply rooted core story that is no longer serving you. You will then be walked through a clearing process to replace limiting beliefs with new life affirming ones.

6. Confidentiality: We keep all information that we receive from you, confidential, and do not disclose it to persons outside our company. All client information is kept strictly confidential and is for our internal use only.

Information shared regarding child physical and or sexual abuse will be reported to proper authorities if the said offender has access to children.

7. Your Choice, Your Responsibility:

While, during your session, we will offer you advice and other ways of looking at your problem and its solutions for your consideration, you hereby agree that whatever we discuss is only our perspective and is not binding upon you, nor is it a prescription. If you want to discuss our suggestions with someone else, you should discuss them with a licensed health care provider. It is your responsibility to confirm whether or not any changes we made produced the desired results. It is your responsibility to communicate your results to us. Our liability is limited to the amount paid for the therapy.

8. Cancellation Policy and Fees:

While we appreciate the complexity of life situations, we also agree to honour you as responsible for your life and your decisions.

9. Termination of Practitioner / Client Relationship: If the practitioner terminates the relationship due to the belief that she cannot help, following information received from the client at any time, the practitioner will end the relationship.

By clicking YES below you have fully read and agreed to the above waiver.

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