Please fill out the below form prior to our first session together Name * First Name Last Name What is your intention for your breathwork sessions? * Note - this can and may change throughout our time together Health Conditions Due the nature of the breathwork that we will be doing, below are a series of questions to ensure I can best support you during this process. Do you have any health (mental, emotional or physical) concerns that should be known about? * e.g. anxiety, depression Do you have or have a family history of mental health conditions? If so, please explain * Do you have any heart conditions or high blood pressure? * Yes No Are you pregnant? * Yes No Do you have epilepsy? * Yes No Is there anything else you would like me to know before our breathwork session together? * Refund & Cancellation Policy * I understand that breathwork is used for stress reduction, relaxation and self improvement. I understand that breathwork practitioners do not diagnose conditions nor do they prescribe or perform medical treatment, prescribe substances, nor interfere with the treatment of a licensed medical professional. I understand that breathwork does not take the place of medical care. It is recommended that I see a licensed physician or licensed health care professional for any physical or psychological ailment I may have. I understand that breathwork can complement any medical or psychological care. I understand there are no refunds for services. I understand once payments are received there are no cancellations. I agree Thank you!
