To help us support you well during the Grof® Breathwork experience, we ask you to complete the below health information questionnaire. If we are concerned that a condition may affect or contraindicate your participation, one of our senior faculty members will contact you by email and make an appointment to discuss our concerns. In the rare case that participation does not seem safe, your registration fee will be refunded in full. In some situations, we may ask you to modify your participation. Often, just knowing about a situation will help us work with you safely during the workshop.
Please note that your responses to this questionnaire will be viewed only by our facilitation team and kept strictly confidential. Grof Legacy Training USA is a training organization and not a health care provider or other entity required to retain information in compliance with requirements of the Health Insurance Portability and Accountability Act (HIPAA). Your responses to this questionnaire do not constitute a medical record.
When considering this questionnaire, please note that 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 support you 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. 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.
If you have any difficulties accessing or submitting this form, please contact Gianna Sutley at gianna@grof-legacy-training-usa.com If you have any questions or concerns about the health information, please contact Marianne Murray at mariannemurray@earthlink.net.