Health Declaration Form

PERSONAL HEALTH STATEMENT

I, Joanna Hall, will ensure that the breathwork activities are carried out safely and correctly. However, I cannot assess the health risks particular to individual participants.

The contraindications for participation in the breathwork are:

Pregnancy – any stage
Severe PTSD or trauma
Actively using recreational drugs
Taking any medication that alters brain chemistry like anti-anxiety, anti-depressant, ADD, OCD medications etc
Detached Retina
Glaucoma
Kidney disease
High Blood Pressure
Cardiovascular disease, including angina, previous heart attack or stroke
Diagnosis of aneurism of any kind
Uncontrolled thyroid conditions
Diabetes (any type)
Severe Asthma – for mild to moderate asthma, we can discuss but you must bring your inhaler to the session
Epilepsy
History of seizures
Prior diagnosis of bipolar disorder, schizophrenia or previous psychiatric condition
Severe psychosomatic disorders
Recent surgery, stitches or injury
Hospitalization for any psychiatric condition or emotional crisis within the last 10 years

All participants assume personal responsibility and are advised to consult their personal physician should they be suffering with any serious health condition or in any doubt as to their physical ability to take part. The participant ultimately decides whether they are fit to take part. Any breathing techniques learned during the workshop should be practised in a safe place, and NEVER practised in water or whilst operating machinery or driving a vehicle.

PERSONAL LIABILITY STATEMENT “I hereby declare that I participate in these breathwork sessions voluntarily and entirely at my own risk. I shall not hold Joanna Hall liable for any damages and/or injury resulting from participation in the breathwork session.”

HEALTH DECLARATION “I hereby declare that I have been adequately informed about the contraindications of this breathwork session beforehand and that I am in good physical and mental condition. I shall not hold Joanna Hall liable for any damages and/or injury resulting from participation in the Breathwork Session. My participation is entirely at my own risk".