How can we reach you?
Have you Ever Done Breathwork Before?
The next few question will help me understand your medical history and tailor your breathwork experience to your needs.
Do you have a history of any psychological or physical health conditions? If yes, please describe the conditions and the treatment or guidance you received. Are these issues currently active or resolved?
Are you currently experiencing any active trauma? This could be a big event, every day occurrences (such as emotional or work place abuse), childhood trauma or generational trauma. If yes, how are you managing it?
Do you have a history of burnout or adrenal fatigue?
Please check any of the following contraindications that may apply to you.
Please know that the list above is the detailed list of contraindications for practicing open-mouth circular connected breath or three-part breath. If you have any of these conditions, we will discuss alternative breathing practices that will still be very healing.
Please check any of the following that may apply to you.
If you have any of the above, it may be a sign that your nervous system is in a dysregulated state. It may be recommended we work on a breathwork practice to help bring the nervous system back into a more regulated state before working with the open-mouth circular connect breath or three-part breath.
Taking into account that we often make use of sound/music is there any specific type of music you have issues with or stimulates you greatly?
The following questions ensure we are both aligned for outcomes and expectations during our session.
I understand that it is not advised to combine drugs or alcohol with breathwork. I will refrain from using any substances the same day that I practice breathwork.
I acknowledge that practicing breathwork may bring up deep emotional and/or physical release of tensions or traumas stored in my body.
I understand that breathwork is powerful and I need space in my schedule to allow space for healing and integration after each session.
I understand that the therapy provided by Megan Cleveland through Tenaciously Still Wellness, LLC carries risks. By participating, I assume all risks and responsibility for any loss or damage. I agree to release, waive, discharge, hold harmless, defend, and indemnify the Breathwork Facilitator and their representatives from any claims or losses that may arise from the breathwork. I agree to participate in all breathwork. If I have any medical conditions, I have consulted my physician to ensure breathwork therapy is appropriate for me.
Is there anything else you’d like to share with me before our session?
Please review and acknowledge the following important information.
By signing below, you agree that you have read and accept the terms and conditions of this agreement. If you do not agree or need further clarification, please email Megan at tenaciouslystill@gmail.com
Type your full name to sign this form.
