top of page
Breathwork for High Performers: Enhance Focus, Reduce Stress, Find Flow, and Achieve Peak Performance. If you're interested in learning more please don't hesitate to reach out to schedule an initial introductory call.

New Client Form

Are you currently healthy?
There are certain contraindications to certain forms of breathwork. Please check any that apply.

Volunteer Declaration and Waiver Form By checking the box below, I acknowledge that I participate in Breathwork voluntarily and at my own risk. I understand that there are potential risks associated with breathwork activities. I acknowledge that Stephen Kaminsky is a certified breathwork practitioner but is not licensed in any other medical field. Therefore, I release Stephen Kaminsky from any liability for damages and/or injury resulting from my participation in Breathwork. Health Declaration By checking the box below, I acknowledge that I have been adequately informed about Breathwork activities beforehand and that I am in good physical and mental condition. I understand that it is my responsibility to notify Stephen Kaminsky of any physical injuries or psychological conditions I have prior to participating in Breathwork and that I answered the above form honestly. I acknowledge that my participation in Breathwork is entirely at my own risk. By checking the box below, I acknowledge that I have read and fully understand all the terms of this declaration agreement and have executed this agreement forum voluntarily and of my own free will. I understand that the Breathwork practice is not intended to cure or replace any medical treatment. I am aware that emotions may be evoked during the session, and I take full responsibility for my physical, mental, and emotional experiences during and after the session. I understand that I have the right to terminate the session at any time. By checking the box below, I hereby agree to release and hold harmless Stephen Kaminsky from any and all legal responsibility or liability for any outcomes experienced as a result of participating in Breathwork. I or my representative agree to fully release and hold Stephen Kaminsky harmless from and against any claims, liability, or damages arising out of or in connection with my participation in Breathwork sessions. By checking the box below, I confirm that I have read and understand the above information, and I attest that my general health is good to participate. I declare that I do not have any physical or psychological conditions that would be contraindications for participating in Breathwork. I agree to the above terms and conditions.

Thank you! Look forward to working and breathing together.

bottom of page