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Integrative Breathwork is intended as a personal growth experience and is not a substitute for  psychotherapy. Integrative Breathwork can involve dramatic experiences accompanied by strong emotional and physical release.

Contraindications: This workshop is not appropriate for pregnant women, or for persons with severe cardiovascular disease, severe hypertension, bi-polar disorder, schizophrenia, glaucoma, retinal detachment, recent surgery or fractures, acute infections, or epilepsy.

The answers to the following questions are to assist your facilitator and will be kept confidential.

Medical Intake Form

What are your Pronouns? (this helps us understand the best way to address you.)
Please check if you currently suffer from or have a history of the following.
Are you currently pregnant?
Have you ever been hospitalized for medical reasons or because of an accident?
Have you ever been psychiatrically hospitalized?
I hereby confirm that I have read and understood the above information and have answered all questions completely and honestly and have not withheld any informaton. My general health, as far as I am aware, is good.

Thanks for submitting your intake form.

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