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Breathwork
Waiver and Release Form
Ethereal Lotus Healing Arts
I understand that if I am taking any medications or have any medical conditions
such as, but not being limited to:
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Schizophrenia, unmedicated bipolar or psychosis, unmanaged PTSD, epilepsy or seizures, heart
conditions or arrhythmia, COPD or pre-existing lung conditions, delicate and/or first trimester
pregnancy, high blood pressure, very low blood pressure with fainting history, severe asthma,
glaucoma and/or detached retina, severe osteoporosis, or recent major surgery, that I must inform the facilitator of this session. It's important to add that low blood pressure by itself is not a contraindication unless there is a fainting history. It's also important to add that connected breathwork may not be suitable for people with compromised immune systems, chronic burnout, fibromyalgia, cancer or other severe physical conditions which may add stress to an already compromised physiology.
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In any of these cases, modified practice options may be offered to you. The facilitator may on
occasion advise that breathwork is not suitable for you. We also advise that people experiencing
panic attacks and high anxiety levels use a modified practice.
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Please let us know if you have recently been using micro-dosing protocols.
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Whilst I have been accepted as a participant for this session, I accept responsibility for any consequence resulting from this practice. Jeannette & Ethereal Lotus Healing Arts are not substitutes for consulting your GP or primary medical care provider.
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In the event of any known medical conditions, I certify that I have consulted a health professional
regarding any condition (physical, mental or emotional) that could interfere with my judgment or
affect my health in any way during, or after the session.
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In-person sessions only:
I am aware that appropriate touch may be used for the purpose of supporting my wellbeing and
comfort. Touch is used only with informed consent.
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By participating, I confirm that I have read this waiver and take full responsibility for my own health and well-being.​
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Contact Us
Jeannette Rodriguez
Ethereal Lotus Healing Arts School
Email Address: ethereallotushas@gmail.com
Effective as of August 20, 2022
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