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Breathwork Intake Form

Please fill out the following form with a bit of information about you.

​Please review the following list of breathwork contraindications. If you are currently pregnant, breathwork should not be performed at all. For the rest of the contraindications, please consult with your healthcare provider before participating in a breathwork session.

  • Pregnancy

  • Cardiovascular disease

  • Angina

  • Heart attack

  • High blood pressure

  • Glaucoma

  • Retinal detachment

  • Osteoporosis

  • Recent injury or surgery

  • Any conditions for which you take regular medications

  • History of panic attacks, psychosis

  • Severe mental illnesses

  • Seizure disorders

  • Family history of aneurysms

  • Coronavirus or flu-like symptoms

Thanks for submitting! I’m looking forward to our breathwork session!

Breathwork Preparation

I'm so excited about our upcoming Breathwork session. There are a few things we need to take care of before the session.

Please watch this video and fill out the intake form below.

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