Medical Form

As part of the registration process for a retreat including GROF® Breathwork, we provide you with the following information and ask you about certain medical conditions that may contraindicate participation in Grof informed breathwork. Please indicate “yes” or “no” in the drop down box for various medical conditions and answer the additional questions provided. Space will be provided at the end of the form for explanations where appropriate.

GROF® Breathwork is intended as a personal growth experience and is not a substitute for psychotherapy or medical care. We will use our best efforts to keep you safe but ask you to take responsibility for your own well-being, including deciding whether the workshop is appropriate for you and seeking any outside assistance following the workshop that may be appropriate for integration of issues that may have arisen through breathwork. If you have any doubt whether you should participate, it is essential that you consult your physician and/or therapist as well as workshop organizers before attending.

Please be aware that breathwork can involve strong physical and emotional experiences. This workshop is not appropriate for pregnant women or for persons with cardiovascular problems such as heart attacks, cardiovascular surgery, severe hypertension, arteriosclerosis, angina pectoris, or arrhythmia. The workshop is also not appropriate for people with recent surgery or fractures, acute infectious illnesses (including Covid 19), grand-mal epilepsy, some diagnosed psychiatric conditions, or active spiritual emergency.

Your answers to the following questions will be used by workshop organizers and facilitators to help keep you safe. This information will be kept confidential and will be seen only by those responsible for the workshop. In addition to reviewing the information you provide in this form, we may ask you for additional information and/or have discussion with you about whether participation is appropriate for you at this time. If discussion indicates your participation is not presently appropriate, any deposit you provided for a workshop will be fully refunded.

*Please read the instructions before completing the form. The Medical Form is not considered your registration.

* This is not your registration.

To complete your registration, return to the Retreat registration page.

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