Medical Form

As part of the registration process for an event including GROF® Breathwork we ask that you read the following information and complete the attached medical form.

GROF® Breathwork is intended as a personal growth experience and is not a substitute for psychotherapy or medical care. We are committed to creating the safest setting possible, but ask that you 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 useful for the 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 a history of 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.

Please indicate ‘yes” or ‘no’ in the drop down box for various medical conditions and answer the additional questions. Space will be provided at the end of the form for explanations where appropriate.

The information you share will be kept confidential and will be seen only by those responsible for the workshop. In addition to reviewing the information you are providing we may reach out to you prior to the workshop if we have further questions or need further information. If discussion indicates participation is not appropriate at this time, any deposit you have made for the event 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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