Hey there, Beautiful Soul!

We’re so excited to have you join us for breathwork! Before we dive into the magic, we need to cover a few important things to ensure a safe and enjoyable experience.

Participant Information:

  • Name: ______________________________

  • Email: ______________________________

  • Phone: ______________________________

  • (Females only, please select one) Are you currently pregnant? YES NO

A Little About Breathwork:

Breathwork is a powerful practice that can lead to emotional and physical release. It’s normal to experience a range of feelings during our sessions—everything from bliss to a few tears. Just know that it’s all part of the journey!

Your Health Matters:

To keep things safe and sound, please let us know if you have any medical conditions we should be aware of, such as:

  • Heart conditions

  • Respiratory issues

  • Seizure disorders

  • Severe anxiety or PTSD

(If so, please share: ________________)

Let’s Keep It Light:

By signing this form, you agree to take responsibility for your own well-being during our sessions. We want you to feel empowered and safe, so please listen to your body and let us know if you need to pause or step back at any point.

These sessions bridge the gap between health and wellness, and the deep stuff. This is not a licensed therapeutic space. If you’re looking for deeper support, I’m here for you! I offer one-on-one somatic therapy and coaching options—just reach out if you're interested.

Liability Release:

While we’ll be here to support you, you release Chanel Vysohlid, The Self-Worth Lounge and any other representatives from any claims or liabilities that might arise during or after the breathwork session. This waiver is just a way to ensure everyone has a safe and transformative experience!

Signature Time:

By signing below, you acknowledge that you’ve read and understood this waiver and are ready to breathe deeply and embrace the journey!

  • Participant Signature: ______________________________

  • Date: ______________________________

Thank you for being part of this experience! We can’t wait to breathe with you!