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Breathwork Liability Waiver & Health Questionnaire

Thank you for taking the time to fill this out prior to your Health and Wellness Empowerment Session. We will be in touch if we require any further information from you.

 

(All information will be kept confidential.)

Health & Safety Acknowledgment

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I/we prioritise the safety and well-being of all participants. Breathwork sessions may not be suitable if you have certain health conditions. Please complete the following questions honestly:

1. Current Health Conditions Required

If you are unsure about your suitability due to a medical condition or medication, please consult your physician before participating.

 

3. Special Considerations

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  • People with asthma should bring their own inhaler and consult with their physician and the session facilitator.

  • Anyone experiencing an emotional or spiritual crisis, or a mental health condition without treatment or support, should not participate.

 

Participant Declaration

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I hereby warrant and represent that:

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  • I am in good physical, mental, psychological, and emotional health.

  • I understand that if I am not in good health, I may be advised not to participate.

  • This declaration allows me to safely participate in the breathwork session.

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I acknowledge that the facilitator is not a doctor, psychiatrist, or healthcare specialist, and that the session is not intended to diagnose, treat, or cure any medical, psychological, or emotional condition.

I voluntarily participate, knowing the potential risks and consequences, and assume full responsibility for any outcomes, known or unknown.

 

Release of Liability

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I hereby release Brooke Stevenson & Luxe Wellness from all responsibilities, costs, and damages that may arise from my participation in the breathwork session. I accept full financial responsibility for any costs related to medical treatment or other consequences resulting from participation.

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By signing below, I acknowledge that:

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  • I have read this waiver and health questionnaire in full

  • I understand and accept the risks

  • I am signing this release freely and voluntarily, without external pressure

  • I waive certain legal rights by signing this document

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Congratulations and Welcome!

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