Breathwork Consent Form
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You’re going to do some breathwork! Yey!
Before we do that, we have some stuff to cover. Please read & ask any questions you may have, prior to class, by emailing me at acupuncturewithrachel@gmail.com
SERVICES & DISCLOSURE
I (the reader) understand breathwork is designed to move stagnation in the body and is not intended to constitute medical advice or substitute western medical care. Breathwork is not a diagnostic tool or treatment for any health problem, and services of Rachel Jensen (and any practitioner present to support) do not replace the care of western medical support.
MEDICAL DISCLAIMER & CONTRAINDICATIONS
Breathwork can result in intense experiences ie: strong emotional and physical responses. I may find breathwork physically, emotionally, or mentally challenging. Breathwork may be contraindicated for people with certain medical conditions and those with a history of the following conditions are encouraged to check with their western medical doctor and/or psychologist prior to involvement in breathwork: Cardiovascular disease or prior heart attack, high blood pressure, use of prescription blood thinners (such as Coumadin), epilepsy or seizures, glaucoma, osteoporosis, severe asthma, bipolar disorder, schizophrenia, dissociative disorders, history of significant trauma, and during pregnancy.
If I am pregnant, and/or if any of the above conditions apply to me, I have advised Rachel and my medical team, prior to participation, and have received their consent to continue with breathwork. I am fully responsible for seeking medical help to treat symptoms that are present before and after breathwork, am physically and mentally fit to participate, and understand that it is my responsibility to seek professional support after breathwork if I feel unstable mentally or emotionally.
RISKS
I understand breathwork has certain known inherent risks that contribute to the unique character of breathwork, and that Rachel cannot eliminate, alter, or control these inherent risks. “Risks” include, but are not limited to, known and unknown health conditions, inaccessibility to immediate medical attention, breathwork-related experiences such as over-exertion, psychological distress and disorientation, hyperventilation, respiratory alkalosis, body shaking/twitching, crying, laughing, muscle spasms/tetany, chest pain, numbness, heart attack, death, and injury or death caused by negligence on the part of me or other people around me.
I understand and assume the risk of injury or harm, and agree that my involvement in breathwork is voluntary, and that I elect to participate despite the risks. I indemnify and hold harmless Rachel Jensen and Acupuncture with Rachel for injury or damages that I may sustain because of participating in breathwork.
CANCELLATION POLICY
-There are no refunds after 48 hrs. If you can't make the event, you may transfer your ticket to another circle w/i 2 months.
-Transfer of tickets to another person will not be permitted
-In the case of inclement weather, circles will move to Zoom. No refunds will be permitted.
By attending Breathwork Circle, I agree that I understand and agree to the above and am super excited to do some breathwork!