Health Screening & Waiver

1. Before your first breath with us

Breathwork changes what’s happening in your body: your blood chemistry, your heart rate, your nervous system. That’s the point of it. It’s also why it isn’t right for everyone, and why we ask before you arrive rather than in the room.

Everything you tell us is confidential and is seen only by your facilitator. Please answer honestly. Most conditions don’t stop you attending; they just help us look after you properly.

If anything here worries you, don’t guess. Email hello@breathation.com and we’ll talk it through.

2. When you’ll be asked

3. What we ask about

Your details and an emergency contact, then whether you currently have, or have ever had, anything in these areas. If you’re not sure, tick it and we’ll talk.

There’s also an optional box for anything else you’d like your facilitator to know about your body, your history, or how you’d like to be supported. It’s often the most useful box on the form.

4. If you tick something

Almost none of these will stop you coming. Most people who flag something attend exactly as planned. Every answer goes to a person, never an automatic decision.

5. How we look after your answers

• Stored securely against your customer record in Momence, never in a spreadsheet or email
• Visible only to Trav and the facilitator teaching your session
• A timestamped record of which version of the waiver you accepted, and when
• Kept for 7 years from your last visit, as set out in our Privacy Policy
• You can ask for a copy at any time

6. Waiver, release and assumption of risk

Breathation · T Facilty Services Pty Ltd · ABN 65 690 011 011 · Version 1.0

1. What breathwork involves

I understand that Breathation delivers guided conscious connected breathwork and related practices, which may include sustained rapid breathing, breath retention, movement, sound and music.

2. Risks I understand and accept

I understand these practices may cause, among other things:

• tingling, numbness or pins and needles
• muscular tension, cramping or tetany, particularly in the hands, feet and face
• dizziness, light-headedness or fainting
• changes in heart rate and blood pressure
• feeling hot or cold, sweating, shaking or trembling
• nausea, headache or chest tightness
• strong emotional release, including crying, laughing, anger or fear
• distressing memories, images or feelings surfacing, including memories of traumatic events
• altered perception, disorientation, or a sense of time distorting
• in rare cases, more serious physical or psychological effects

I understand this list is not exhaustive and that reactions vary between people and between sessions.

3. My honest disclosure

I confirm that I have completed the Breathation health declaration honestly and completely, and have not withheld anything relevant. I understand that Breathation is relying on what I have told them to decide whether it is safe for me to take part. I agree to tell Breathation before any future session if my health changes.

4. My own responsibility

I confirm that:

• I am participating voluntarily
• I am 18 or over, or a parent or guardian has consented in writing
• I have obtained medical clearance where Breathation asked me to, or where I had reason to think I needed it
• I am not under the influence of alcohol or recreational drugs
• I will follow the facilitator’s instructions
• I will stop, rest and signal for help if I need to, and I can pause or leave at any time without explaining myself
• I am responsible for monitoring my own experience and choosing my own level of intensity

5. This is not medical treatment

I understand that breathwork at Breathation is not medical treatment, psychological therapy, counselling or a substitute for any of them; that Breathation facilitators are not registered medical or mental health practitioners unless specifically stated; that no diagnosis, treatment, cure or outcome of any kind is promised or implied; and that I will not stop or change any treatment or medication because of anything experienced or said at Breathation.

6. Emergency care

I consent to Breathation calling emergency services and administering or arranging first aid if they reasonably believe I need it, and to them giving relevant health information to emergency responders. I accept responsibility for the cost of any ambulance or medical treatment.

7. Release and assumption of risk

8. Confidentiality of others

I agree that anything I see or hear about another participant during a session is confidential, and that I will not repeat or share it.

9. Images (optional)

A separate, unticked box. Saying no never affects a booking, and consent can be withdrawn at any time: “I consent to Breathation photographing or filming me and using those images to promote Breathation.”

10. Privacy

I consent to Breathation collecting, holding, using and disclosing my personal and health information as described in the Privacy Policy, and understand I can access, correct or ask about it at any time.

11. Acknowledgement

I have read and understood this waiver, I have had the opportunity to ask questions, and I am signing it freely. Typed full name and date are recorded at checkout; a parent or guardian signs for anyone under 18.

7. Touch and consent

Our facilitators don’t use touch during sessions.

8. After your session

An hour or two after your session we’ll send a short note on how you might feel tonight. Tired is normal. Emotional is normal. Wide awake is also normal. Drink water, eat something, be gentle with yourself, and don’t make big decisions tonight. If anything is still sitting uncomfortably tomorrow, reply to that email. We read them all.