Disclaimer for working with the Conscious Connected Breath

Breathwork can result in certain specific physiological changes in the body and also intense physical and emotional release.

Please be aware that these sessions can cause and are not limited to:

* Tingling
* Dizziness
* Trembling or shaking other physical sensations
* Emotional experiences

As a precaution, the following conditions are contraindicated. It is crucial that you inform your breathwork practitioner if any of the following conditions are relevant to you:

* Pregnancy
* Detached Retina
* Glaucoma
* High Blood Pressure (not controlled with medication)
* Cardiovascular disease including angina, previous heart attack or stroke.
* Diagnosis of aneurysm in the brain or abdomen
* Uncontrolled thyroid conditions and diabetes
* Asthma - if asthmatic, it’s OK to attend if you bring your inhaler to the session.
* Epilepsy
* Prior diagnosis of bipolar disorder, schizophrenia or previous psychiatric condition.
* Hospitalisation for any psychiatric condition or emotional crisis within the last 10 years.
* Any other medical, psychiatric or physical conditions which would impair or affect ability to engage in any activities that involve intense physical and/or emotional release.

It is each participant’s responsibility to look after their own physical, emotional and mental wellbeing. Emma Wise takes no responsibility for injury you may sustain as a result of participating in this session.

Please delete Yes or No as appropriate below …

I have contraindications: Yes/No

I have contraindications and have informed Deborah: Yes/No/NA

I have read the session guidelines (in your confirmation e-mail): Yes/No

I take full responsibility for my processing after the session and will communicate with Emma if anything should arise that I don’t feel comfortable with (one to one sessions may be recommended for those needing more support): Yes/No

My Next of kin/emergency contact, who will be available during my breathwork session is:

Name:

Number:

My level of experience with the Conscious Connected Breath is: beginner/intermediate/experienced

I am aware that the Conscious Connected Breath is a powerful healing modality and I agree to the Terms and Conditions above

My name:                                       Date:              My phone number: