Holistic Therapy for Anxiety in Stone Oak

We prioritize the safety and well-being of all our participants, and as part of our commitment to
ensuring a secure environment, we require the completion of this Liability Waiver Form.

A breathing session may not be suitable for you if you have the following conditions: Cardiovascular
problems, abnormally high blood pressure, aneurysms, epilepsy and seizures in the past, anyone
taking heavy medication, severe psychiatric symptoms especially psychosis or paranoia, bipolar,
osteoporosis, recent surgery, glaucoma or is currently pregnant.

People with asthma should bring their own inhaler and consult with their physician and breathing
session instructor before participating. Anyone experiencing an emotional or spiritual crisis or any
person with a mental illness who is not in treatment or lacks adequate support. Please note, this
list is not exhaustive, and we generally advise that if you have a question about a condition, you may
have that is not listed here, you consult a physician before participating in these breathing sessions.

I warrant and represent that I am in good health physically, mentally, psychologically and
emotionally, and I understand and warrant that if I am not in good health, I will not be allowed to
perform the activities and sessions. Accordingly, the declaration and certification that I am in good
health in all the above-mentioned respects constitutes a material agreement to allow me to
participate in the breathing sessions.

I know and acknowledge that the person facilitating is not a doctor or psychiatrist, or a specialist
in health care, and that the activities offered are not intended to treat and diagnose specific
medical conditions, whether physical, psychological or emotional.

I voluntarily participate in these activities knowing the risks and consequences and agree to
assume all consequences, known or not.

I release the trainer from all responsibilities, costs and damage that may arise from participating in
the above-mentioned activity.

I agree to accept financial responsibility for costs related to treatment—payment is taken care of
before your session starts so you can just relax and focus on you!

By adding my name below, I acknowledge that I have read the above warning and agree to proceed
with full responsibility and understand that I have waived certain rights by signing and signing this
release of liability freely and voluntarily without any external influence.

Name:

Signature:

Date: