Consious Connected Breathwork

Consious Connected Breathwork

This information asked in this form is to help ensure your wellbeing during the session, give you some information about what to expect and to make you feel empowered to take responsibility for your own Breathwork journey.
Name

First NameLast Name
Email
example@example.com
Would you like to be added to Pink Griffin's mailing list (few emails/year)?
Phone Number
Would you like to be added to What's Up group with Pink Griffin events?
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Have you experienced Conscious Connected Breathwork or similar type of breathing before?
Contraindications and disclaimer:

This practice is not a substitute for medical advice, so it's important that if you experience any of the following, you should consult your GP or primary healthcare provider first:
- Schizophrenia
- Unmedicated bipolar disorder or psychosis
- Unmanaged PTSD
- Epilepsy or seizures
- Heart conditions or arrhythmia
- COPD or pre-existing lung conditions
- Delicate and/or first trimester pregnancy
- High blood pressure (hypertension)
- Very low blood pressure with fainting history (hypotension)
- Severe asthma
- Glaucoma and/or detached retina
- Severe osteoporosis
- Recent major surgery
- Vertigo
- Severe panic attacks or acute anxiety
- Currently on microdosing protocols
One or more listed conditions apply to me:
If answered YES, please provide more details:
It will still be possible to attend the session, and if you experience any of the conditions listed above, I will recommend a modified nose breathing practice for you.

Connected Breathwork can be a dynamic practice and as such, in reading this waiver you agree to take personal responsibility for your process.
I have read and understood the above disclaimer