For your safety, please read Contraindications for Breathwork below, and the Waiver that sits below that. As a trauma-informed Practitioner, your safety is my number one priority, and your informed consent is key to this.

Breathwork Contraindications 

You'll need to be at least 18 years of age to attend a Breathwork workshop.

Breathwork is not recommended for people with a personal or family history of epilepsy, seizures, cardiovascular problems including angina or heart attacks, high blood pressure, aneurysms, glaucoma, retinal detachment, osteoporosis, or recent physical injuries, surgery or illness - particularly involving the brain, mouth, teeth, nose, throat, thyroid, immune system, lymphatic system, lungs, chest, ribs, spine, neck and/or reproductive organs.

Breathwork is also not recommended for people with a personal history of mental illness, personality disorders, hospitalization for any psychiatric condition or emotional crisis, suicidality, psychosis, drug or alcohol addiction.

This particular style of Breathwork is not safe for you if you are pregnant.

Please consult with your healthcare provider (including any mental health services you receive) before a session if you have any of these contraindications, or if you're unsure if Breathwork is right for you.

Waiver

Gemma Slack does not process insurance claims.

I certify that I am a competent adult of at least 18 years of age.

This Informed Consent is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assignees.

I certify that I am in adequate physical, emotional and mental health to participate in a Breathwork session.

 I acknowledge that should this information change, it is my sole responsibility to notify my Breathwork Facilitator (Gemma Slack).

I consent to and authorize Gemma Slack to guide me in a Breathwork Session as specified by my facilitator. This session may include energy healing, vocal toning, tapping, touch work and integration coaching support.

I understand that Gemma Slack is not a licensed physician or functional breathing specialist and does not dispense medical advice or prescribe the use of any technique as a form of treatment for any physical or psychological conditions without the advice of a physician - either directly or indirectly.

As a Breathwork Facilitator, Gemma Slack offers information of a general nature to help clients in their journey toward greater self-awareness, mind-body connection, emotional, mental, physical, and spiritual wellbeing and Gemma Slack assumes no responsibility for how I (the client) may use this information.

Breathwork is not recommended for people with a personal or family history of epilepsy, seizures, cardiovascular problems including angina or heart attacks, high blood pressure, aneurysms, glaucoma, retinal detachment, osteoporosis, or recent physical injuries, surgery or illness - particularly involving the brain, mouth, teeth, nose, throat, thyroid, immune system, lymphatic system, lungs, chest, ribs, spine, neck and/or reproductive organs.

Breathwork is not recommended for people with a personal history of mental illness, personality disorders, hospitalization for any psychiatric condition or emotional crisis, suicidality, psychosis, drug or alcohol addiction.

Possible side effects may include dizziness, fainting, changes in body temperature, disorientation, tingling, carpopedal spasms, cramping, emotional breakthroughs, feeling physical, mental, energetic and/or emotional triggering and/or vulnerability.

I acknowledge and understand that I must not consume alcohol or any other mind altering substances within the 24 hours prior to the Breathwork session otherwise it cannot go ahead.

The nature of the service/session has been explained to me and/or is available to me in writing and any questions I had regarding the session(s) have been answered to my satisfaction.  I understand that the session may involve risks of complications or injury from both known and unknown causes, and I freely assume these risks.

I understand that I have the right to refuse to participate in the session. No guarantee, warranty or assurance has been made to me as to the results that may be obtained. I certify the above information is correct to the best of my knowledge.

I agree to adhere to all safety precautions and regulations during my treatments/sessions with Gemma Slack. I will not hold Gemma Slack or any associated companies or members of their staff responsible for any errors or omissions that I may have made in the completion of this form.

By ticking this box I agree to the above.