Completion of this form is required before attending your first session. Your information is held in strict confidence and is used solely to support your attendance. 

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Breathwork can involve physical, emotional, and physiological responses. Please answer honestly.

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If you have any questions or concerns before completing this form, feel free to get in touch

(contact information at the end of the form).

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Acknowledgement & Consent

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Please read carefully before confirming.

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By completing this form you confirm that the information you have provided is accurate and complete to the best of your knowledge. You understand that breathwork is not a substitute for medical or psychological treatment. You confirm that you are participating voluntarily and undertake the course at your own risk, accepting full responsibility for your physical, mental, and emotional wellbeing during and after the course. You agree to inform the facilitator of any changes to your health prior to the course commencing.