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Breathwork Session Disclaimer

IMPORTANT NOTICE: Please read before participating in breathwork. This information is used solely for the facilitator to ensure the safety of all participants during the session.

Tetany (Involuntary Muscle Contractions)

During breathwork, particularly with deep or accelerated breathing patterns, some participants may experience tetany—a temporary state characterized by involuntary muscle contractions or cramping, most commonly in the hands, feet, or face. This can feel like clenched or curled fingers (often referred to as “lobster claw hands”), tightness in the mouth or jaw, or tingling sensations.           

Tetany is typically caused by shifts in oxygen and carbon dioxide levels during extended or intense breathing and is generally not harmful. It is a sign of physiological activation and often subsides on its own when normal breathing resumes. However, if tetany occurs and becomes uncomfortable, I am encouraged to slow down, return to nasal breathing (further explained at the beginning of session), or rest until the sensation passes.

By participating in this session, I acknowledge that I have been informed of the possibility of tetany and that I accept full responsibility for how I manage my breath and body throughout the session.  



First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Third Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Middle Name
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
How many times have you done breathwork?*
First Time
1-5 Times
6-20 Times
20+ Times
Are you pregnant?*
No
Yes
Any recent surgeries or physical injuries?*
No
Yes
Any chronic physical ailments?*
No
Yes
Are you currently taking any medications and/or supplements?*
No
Yes

If you are taking any supplements and/or medications, please list?
Are you currently seeking a western healthcare professional?*
No
Yes

Is there any reason to question your ability to safely do breathwork? If so, please briefly describe. *
I understand Breathwork & Meditation is a “complimentary” therapy and is not a substitute for Western medicine, professional and licensed medical examination, diagnosis or western treatment. My information will be kept private and confidential.*
Yes, I understand.
No, I do not understand.
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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