Breathwork Informational Form and Waiver

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Breathwork is a general term that is used to describe multiple types of conscious breathing exercises. Shannon Schueler guides participants through Breathwork as an active meditation. Breathwork is a powerful practice that has the potential to support processing energy imbalances and emotions in the body.* The term “breathwork” refers to intentional or conscious breathing as an active meditation. Currently and historically, communities and cultures throughout the world have used breathwork in meditation and spiritual practices

Shannon Schueler is a registered nurse and board certified holistic nurse trained in facilitating healing through Reiki, Healing Touch, and Breathwork techniques. Shannon's work is not meant to diagnose or treat specific ailments, but to facilitate the ways in which participants enter into an inner space of self healing.

*A breathwork practice can cause strong physical sensations and/or emotional releases. In rare cases, strong emotional releases have been known to cause amnesia.

Please read the following and complete the required questions before the scheduled breathwork facilitation session. To request additional written information about Breathwork, please comment in the last box.

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電子郵件 *

Name *

Address *

Phone number *

Emergency Contact Name and Phone Number *

This will be my first breathwork session: *

Yes

I understand that I am participating in this activity by choice and that I have the right to say yes or no to any suggestion based on what feels appropriate to me. *

Yes

必填

I understand that breathwork may result in temporary bodily sensations such as tingling in hands, feet, and face, my body temperature may shift temporarily, and emotional sensations may take place. *

Yes

必填

I understand that some breathwork is contraindicated for people who have certain medical conditions. I will inform Shannon if I have been diagnosed with any of the following: The first term of pregnancy (unless I have discussed it with my prenatal care provider)*, epilepsy, retinal detachment, Glaucoma, high blood pressure (that is not currently controlled by medication)*, cardiovascular disease, family history of aneurysm, strokes and neurological conditions, or severe osteoporosis. *

Yes

必填

Before the breathwork session, I want Shannon to know:

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