Participation & Consent Form

Participation & Consent Form

Complete your details, review the health and consent statements, and confirm your agreement for the session.
Full Name

First NameLast Name
Email Address
example@example.com
Do you have any medical conditions, allergies, or health concerns we should be aware of?
Session Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Would you like to discuss your participation with us before the session?
Please read and confirm the following:

Other
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Participation in MOMent — Breathwork & Sound Bath is entirely voluntary. You may stop at any time. This session is intended for relaxation and well-being and is not a substitute for medical or psychological treatment. Please consult a healthcare professional if you have any concerns.
Before you join

Please seek medical advice before participating if you are pregnant, have a heart condition, epilepsy, an implanted medical device, recent surgery, acute inflammation, a tumour condition, or a severe mental health condition.

Please contact us before the session if any of these apply, or if you have another condition that may affect your participation. You do not need to describe your medical history in this form.

Do you need to discuss your participation or any adjustments with us?
Should be Empty: