The Breathing Co.
Patient Introduction & Informed Consent 2021
Experiences at the breathing co guide + support deep self exploration and transformation in the physical, mental, emotional, spiritual, and energetic body through a variety of ancient and modern practices. The powerful tools and modalities used at the breathing co create experiences felt in varied levels of consciousness.
Because these experiences can bring up intense emotions and strong physical experiences, I understand that issues arising from my participation at the breathing co may require additional therapeutic or supportive interventions. These experiences have the potential to create both desirable and undesirable effects.
If you are pregnant, taking anticoagulant drugs (ex. Coumadin), have a severe bleeding disorder (hemophilia), have a heart condition, diabetes, circulatory problems, blood clots, cancer/malignancies, bone disorders (osteoporosis/Paget’s disease/multiple myeloma), any serious medical condition, metal implants or a pacemaker, please make this information known to me prior to your treatment.
I acknowledge that I am voluntarily participating in mind architecture and coaching, breathwork based meditation experience, and in some cases plant medicine supported experience, with The Breathing Co.
I understand that any coaching I experience does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association. I understand that coaching is not a substitute for counselling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment.
I acknowledge and understand that I am responsible for all aspects of my health and well-being. I further recognize and understand that the instructions and advice presented to me are in no way intended as substitutes for medical and/or other professional counseling. If I have any health concerns that may interfere with my participation, I understand that I should consult my healthcare provider before beginning the meditation exercises. If I experience pain or difficulty that is cause for concern during or after practicing the meditation exercises, I understand that I should stop immediately and consult my healthcare provider before continuing on with the meditation exercises.
I recognize, understand, and assume all risks associated with my voluntary participation, including, but not limited to, those risks that may result in personal injury and death. In giving my informed consent to participate, I hereby release The Breathing Co from any and all claims, now or in the future, that I may have as a result of my voluntary participation in the breathing co services.
1. 24 hours notice policy for cancellations or changes of scheduled appointments. Clients will be charged the full rate for cancelling or missing appointments with less than 24 hours notice.
2. Be on time for all sessions. If you are late for your appointment, it will still conclude at the scheduled time.
3. All information that you share will be held as confidential, unless there is considerable concern for your safety or the safety of another individual.
4. It is your responsibility to let me know if there are any specific goals or topics you would like to discuss or explore.
5. Payment is due in full at the time of service for both services and products