Application

Psychosomatic Breathwork Training Application

Name*

Phone Number*

Email*

Location*

Are you a licensed mental health professional or mental health student?*

YesNoStudent

Which training are you applying for?

Male CohortFemale Cohort

Please list your credentials:*

How many years have you been in practice? *

Do you have any previous breathwork experience? Please elaborate:*

Contraindications: Breathwork is a safe and natural healing intervention. Please note the following contraindications. If any of the following apply, please consult your doctor before doing breathwork. Cardiovascular problems, untreated high or abnormal blood pressure, history of aneurysms, epilepsy or seizures, on heavy medications, psychosis, paranoia, bipolar disorder, osteoporosis, recent surgery, glaucoma, pregnancy, an active addiction. *

I reviewed the Contraindications.