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Health & Eligibility Declaration

Full name

Email address

Phone

Emergency contact name

Emergency contact phone

I understand that Breathwork is not advisable for individuals who have been diagnosed with or currently have any of the following conditions.

- Uncontrolled high blood pressure

- Epilepsy or history of seizures

- Cardiovascular disease or history of heart attack

- Glaucoma or detached retina

- Severe asthma or respiratory illness

- Bipolar disorder or history of manic episode

- Personal or family history of aneurysm

- Schizophrenia or history of psychosis

- Dissociative disorders

- PTSD or significant trauma history without current professional support in place

- Pregnancy

Untitled checkboxes field

I confirm that I do not have nor have I been diagnosed with any of the above conditions, or that I have obtained clearance from a qualified medical or mental health professional to participate, and accept full responsibility for any decision to proceed on that basis.

By submitting this declaration, I confirm I have read and agree to the Terms & Conditions governing my participation

Signature

This declaration is governed by the laws of Victoria, Australia.