WEITERE INFORMATIONEN
WAIVER - Important please read:
Avaree Breathwork with Danielle Susan Bloch does not process insurance claims. By purchasing a ticket you agree to the waiver.
I certify that I am a competent adult of at least 18 years of age or that if I am a minor under the age of 18, I understand that the consent of my parent/legal guardian/person having legal custody will also be required before treatment.
This Informed Consent is freely and voluntarily executed and shall be binding upon my spouse, relatives, legal representatives, heirs, administrators, successors and assignees.
I certify that I am in adequate physical, emotional and mental health to participate in a Breathwork session.
I acknowledge that should this information change, it is my sole responsibility to notify my Breathwork Facilitator (Danielle Susan Bloch).
I consent to and authorise Danielle Susan Bloch to guide me in a Breathwork Session as specified by my facilitator. This session may include energy healing, vocal toning, tapping, touch work and integration coaching support.
I understand that Danielle Susan Bloch is not a licensed physician or functional breathing specialist and does not dispense medical advice or prescribe the use of any technique as a form of treatment for any physical or psychological conditions without the advice of a physician - either directly or indirectly.
As a Breathwork Facilitator, Danielle Susan offers information of a general nature to help clients in their journey toward greater self-awareness, mind-body connection, emotional, mental, physical, and spiritual wellbeing and Danielle Susan assumes no responsibility for how I (you the client) may use this information.
Breathwork is not recommended for people who are pregnant, have a personal or family history of epilepsy, seizures, cardiovascular problems including angina or heart attacks, high blood pressure, aneurysms, glaucoma, retinal detachment, osteoporosis, or recent physical injuries, surgery or illness - particularly involving the brain, mouth, teeth, nose, throat, thyroid, immune system, lymphatic system, lungs, chest, ribs, spine, neck and/or reproductive organs.
Breathwork is not recommended for people with a personal history of mental illness such as severe anxiety and depression, personality disorders, hospitalization for any psychiatric condition or emotional crisis, suicidality, psychosis, drug or alcohol addiction.
Possible side effects may include dizziness, fainting, changes in body temperature, disorientation, tingling, carpopedal spasms, cramping, emotional breakthroughs, feeling physical, mental, energetic and/or emotional triggering and/or vulnerability.
If any of the above contraindications apply to you at this time, please contact me so that we can organise to consult with your doctor or primary health care provider before going ahead and filling out the Questionnaire and Waiver form and purchasing a 1:1 Online Breathwork Journey ticket.
