By opening this informed consent disclosure, you acknowledge that you understand what you are reading and agree to the following: I agree to engage Nicole Coomer (“COACH”) to provide certain services, which may include the following holistic practices and techniques:· Breathwork Techniques, which Merriam-Webster defines as “conscious, controlled breathing done especially for relaxation, meditation, or therapeutic purposes”; Although COACH is trained to perform the above Breathwork Services, COACH is not a licensed therapist, medical professional, or other mental health care provider. COACH does not represent the Services as any form of health care or psychotherapy. By law COACH may make no health benefit claims for Services. Services may not be regulated by any government or administrative body. COACH also does not provide any type of therapy services, despite the word “therapeutic” being included in the common vernacular of Breathwork. The type of Services utilized by COACH are non-therapeutic in nature and are designed to supplement treatment and/or advice from licensed medical and mental health providers. If any medical symptoms persist or progress, even acutely, you hereby agree to inform your medical provider immediately and seek medical attention. You also hereby agree to notify COACH with any updates to your medical condition after beginning Services and to indemnify COACH of any health issues that may persist or progress while working with COACH.Results Disclaimer: Client also acknowledges that COACH cannot and does not guarantee that implementation of the Coaching Services and Program will provide Client with any specific benefits, or life improvements. The COACH may offer her opinion regarding decisions, but it is the responsibility of Client to make the final decision and choose the best option for his/herself. Client also agrees that he/she is solely responsible for any personal and/or professional decisions and indemnifies COACH from any liability regarding said decision. If, at any point during the Services, you feel any adverse effects from any of the Services and/or techniques defined above, you hereby agree to immediately disclose said effects to COACH and your medical service provider.
Confidentiality Statement: Client understands that some of Client’s personal and confidential information may be disclosed to COACH, as COACH administers the Services. Likewise, if Client engages in a group setting for the Services, Client understands that some of Client’s personal information may be disclosed to other clients. Client agrees to keep all other client information strictly confidential to preserve the experience for the group. COACH hereby agrees to keep all of Client’s personal information confidential and for internal purposes only. However, COACH may use general statements about Client’s progress as testimonials and on COACH’s website and/or marketing materials. Clients may choose to remain anonymous in said testimonials upon prior written consent to COACH. Client understands that pictures or videos may be taken during a breathwork session, and that these pictures and videos may be used for marketing purposes.
Physical Touch Disclaimer: Client understands that Breathwork also includes some physical touch by the facilitator or Breathwork assistants during the experience. The facilitator will ask for consent prior to the start of Breathwork. If a client does not express their desire to not be touched, it is assumed that they wish to engage in the full Breathwork experience, including physical touch.
Breathwork has the following contraindications. It's crucial that you inform the facilitator if you have any of the conditions listed here: Pregnancy, severe asthma (mild and moderate OK with an inhaler), detached retina, glaucoma, high blood pressure not controlled by medication, cardiovascular disease, diagnosis of aneurysm in brain or stomach, uncontrolled thyroid conditions, diabetes, epilepsy, prior diagnosis of bipolar disorder, schizophrenia, or previous psychiatric conditions, hospitalizations, or psychiatric illness in the last 10 years, or any other medical, psychiatric or physical conditions which would impair or affect the ability to engage in any activities that involve intense physical and/or emotional release, including any alcohol and/or recreational drug use within the last 48 hours. It is each individual's responsibility to look after their own health and wellbeing. COACH reserves the right to ask you to stop the breath cycle anytime during the practice if it should appear that your safety or the safety of the group may be at risk.
If you are not ok with these terms please let your facilitators know