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HealingwithMads | Breathwork Waiver & Release Form

PLEASE READ CAREFULLY BEFORE SIGNING

Breathwork is a powerful practice that may involve physical, emotional, and psychological responses. While it can be deeply healing, it is not a substitute for medical or psychological treatment. By signing this form, you acknowledge and agree to the following:

  1. Contraindications for Breathwork

    Breathwork is generally safe, but certain medical conditions may increase risks. You should consult with a doctor before participating if you have any of the following:

  • Cardiovascular disease, including heart conditions, high blood pressure, or prior heart attacks

  • Epilepsy or seizure disorders

  • Glaucoma or detached retina

  • Pregnancy (particularly in later stages)

  • History of aneurysms (personal or family)

  • Recent surgery or serious physical injuries

  • Severe mental health conditions such as schizophrenia or psychosis

  • Respiratory conditions such as asthma, COPD, or other lung diseases

  • Any other condition that may be affected by intense breathing or emotional release

If any of the above apply to you, please consult a medical professional before

engaging in breathwork.

  1. Risks & Responsibilities

    I understand that breathwork may result in intense physical sensations and emotional releases. It may not be suitable for individuals with the conditions listed above. I confirm that I have disclosed any relevant health conditions to the facilitator, Maddy Smith (HealingwithMads).

  1. Personal Responsibility & Medical Disclaimer

I acknowledge that:

  • I am participating voluntarily and take full responsibility for my well-being.

  • Breathwork is not a substitute for medical or psychological treatment. I will consult a qualified healthcare provider if needed.

  • If I feel discomfort, dizziness, or distress, I will stop the session and seek support.

  1. Liability Waiver & Release

I release Maddy Smith (HealingwithMads) from any claims, damages, injuries, or losses arising from my participation in breathwork sessions. I agree that:

  • I assume all risks related to breathwork.

  • I will not hold Maddy Smith liable for any physical, emotional, or mental effects.

  • I waive my right to legal action against Maddy Smith for any issues arising from my participation.

  1. Confidentiality & Consent

I understand that:

  • My personal information will be kept confidential and not shared without my consent.

  • Any recordings or images taken during sessions will only be used with my permission.

  1. Acknowledgment & Agreement

By signing below, I confirm that I have read, understood, and agree to the terms outlined in this waiver. I participate voluntarily and take full responsibility for my experience.

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