Virtual Breathwork Journey Intake Form and Safety Checklist


Breathwork is a big, life-changing work. The journey of breath is a journey of self-love, of higher compassion and multifaceted awareness. By breathing into the unknown, we bring life and energy to that which is buried or stagnant. Through breath, we enliven the lost parts of us and return them back into wholeness.

The majority of breathers first experience deep emotional and/or physical release. It is possible to feel anything from grief/pain/discomfort to ecstasy/joy/bliss and anything in between. Again, these are parts of self that are not being met in waking life and thus want the freedom to be completely and uninhibitedly expressed in a safe container of expression, as we will create.

The endless life-force, creativity and vitality is available to us now. Let the breath show you.


Spiritual and emotional work, breathwork, yoga, meditation and any other form of alternative healing should not be construed as a substitute for direct medical advice from your doctor or other qualified clinician, medical or psychiatric examination, diagnosis or treatment. Anyone interested in breathwork is also responsible for seeking the specific medical or psychiatric attention they need, should they need it.

The information and content available is intended for informational purposes only. It is not intended to diagnose, mitigate, treat or cure any disease or condition. Individuals should consult a qualified health care provider for medical advice.


Below are a list of contraindications for conscious, connected breathing. If you are on the contraindication list, you are not a candidate for full breathwork but we are happy to discuss modified, gentle breathwork with you for a later date.

Note: Breathwork results in certain specific physiological changes in the body and also can result in intense physical and emotional release. As a precaution, the following conditions are contraindicated in certain breathwork practices. It is crucial that you inform your breathwork practitioner if any of the following conditions are relevant to you:

– Pregnancy (at 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 aneurysm in the brain or abdomen

– Uncontrolled thyroid conditions

– Diabetes

– 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

– Hospitalisation for any psychiatric condition or emotional crisis within the last 10 years

– Any other medical, psychiatric or physical conditions which would impair or affect ability to engage in any activities that involve deep physical and/or emotional release

Please make sure you are not on the contraindication list before filling the form.