This form is here to make sure your breathwork experience is safe, supportive, and enjoyable. My intention is to create a space where you can explore your breath with ease and confidence. To ensure that breathwork is safe and appropriate for you and that there are no contraindications, please take a moment to review the health considerations listed below. By signing, you confirm that you have read and understood the information. 

 

Health Conditions & Contraindications 
Breathwork can produce powerful physical, emotional, and psychological responses. Therefore, it is not advised for persons with a history of:

• Uncontrolled high or abnormal blood pressure
• Arrhythmias or other serious heart conditions, including prior heart attack or history of stroke/aneurysm 
• Severe asthma or other serious respiratory conditions 
• Epilepsy or history of seizures
• Pregnancy 
• Recent surgeries, fractures, or serious physical injuries (please leave a note below about what kind of surgery you had)
• TBI
• Glaucoma or retinal detachment 
• Unstable or unmanaged chronic illnesses (e.g., diabetes, osteoporosis) 
• Severe or unmanaged mental health conditions (e.g., psychosis, bipolar disorder during active phases) 
• Use of heavy or consciousness-altering medications (e.g., sedatives, benzodiazepines, antipsychotics, narcotics) 
• Active substance use without support or recovery

IMPORTANT

I agree to disclose any medications or substances that may affect mood, consciousness, or the nervous system. I understand that a session may be postponed or rescheduled if this information, or any safety concern (including being under the influence of alcohol or drugs), indicates it would be unsafe to proceed.

I confirm that I have reviewed this list of health considerations and contraindications, and have consulted or will consult a medical or mental health provider if I am uncertain about my readiness to participate.

I understand that breathwork sessions are experiential and non-clinical, and are not a substitute for professional medical or mental health care. I participate voluntarily, take responsibility for my own well-being, and understand that the facilitator is not liable for outcomes. This waiver applies to both in-person and online sessions.

What happens next?

Once submitted, your information will be reviewed to confirm your readiness for a Breathwork session. You will receive a follow-up email (angela@letsget-real.com) with session details, preparation instructions, and next steps to schedule your experience. If you don’t see the email in your inbox shortly, please check your promotions or other folders, or reach out to me directly, angela@letsget-real.com.