Ninja +Positive Breathwork Contraindications

Breathwork results in certain specific physiological changes in the body and also can result in intense physical and emotional release.

Therefore, for safety purposes, all participants are required to complete the following survey prior to attending their first breathwork experience.

If you have any doubt about whether you should participate, consult your physician or therapist, as well as the facilitators before attending. The answers to the following questions are to assist your facilitators and will be kept strictly confidential. Please answer all questions below. Any “Relevant” answers must be explained in detail in the 'ANY OTHER INFORMATION' box.

Medical Contraindications
🔸Relevant if: Either you, or more than one person in your immediate family (parent, child, sibling) has had one.
🔸Relevant if: You have asthma and use an inhaler.
🔸Relevant if: You have cardiovascular irregularities including prior heart attack.
🔸Relevant if: You have detached retina.
🔸Relevant if: You have epilepsy and are susceptible to seizure.
🔸Relevant if: You have glaucoma or damage to the optic nerve.
🔸Relevant if: You have high blood pressure THAT IS NOT controlled with medication.
🔸Relevant if: You have any history of strokes or seizures.
🔸Relevant if: You have osteoporosis or other weak bone symptoms.
🔸Relevant if: You are currently pregnant.
🔸Relevant if: You are using prescription blood thinning or anti-clotting medications (such as Warfarin or Coumadin)
Psychiatric Contraindications
🔸Relevant if: You have a prior diagnosis by a health professional.
🔸Relevant if: You have been hospitalised for ANY psychiatric condition or emotional crisis in the past 10 years such as attempted suicide, nervous breakdown, etc.
🔸Relevant if: You have a severe case and are under a therapist's care.
🔸Relevant if: You have any other medical, psychiatric or physical conditions which would impair or affect your ability to engage in activities involving intense physical and/or emotional release.
🔸I understand that Ninja +Positive Breathwork is intended as a personal growth experience and should not be used as a substitute for psychotherapy.
🔸I understand that Ninja ⊕Positive Breathwork could involve dramatic experiences accompanied by strong emotional and physical releae.
I ACCEPT THAT THIS IS A SELF-ASSESSMENT, AND IT IS MY OWN RESPONSIBILITY TO COMPLETE THIS FORM ACCURATELY AND HONESTLY TO THE BEST OF MY KNOWLEDGE.

I hereby confirm that I have read and understood the above information and answered all questions completely and honestly, and have not withheld any information. If there are any changes in regards to the answers on this form between now and the time of the workshop, I will notify David Harper at NewLife Ninja in writing or email immediately.

My general health, as far as I am aware, is good.

This information will be re-confirmed prior to the start of the breathwork experience.
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