top of page

Pre Breathwork Questionnaire & Waiver



Presented by ADRIAN RAMBLA,
Founder & CEO aT RAEMBLA

I will guide you through a transformative journey that will help you to release trauma, blockages and low vibrational energies stored in your body.
It will expand and increase your energy bringing a total awareness and bliss

Conscious Connected Breathwork 

Health Waiver and list of Medical Conditions which may be 



I understand that if I am taking any medications or have any medical conditions such as the 

contra-indications below, but not being limited to the following , then I will either regulate my practice or seek advice from a  relevant health care professional:




  • Untreated PTSD

  • Lung Conditions such as COPD / Severe Asthma

  • Long Covid Symptoms (please inform the facilitator) 

  • Glaucoma

  • Epilepsy

  • Bipolar

  • Psychosis

  • Schizophrenia

  • Heart Conditions

  • Delicate or Early Pregnancy (first trimester) 

  • High/very low blood pressure with fainting history

  • Recent Major Surgery (within the past 12 months) 

  • Osteoporosis: Recent hospitalisation: Severe bone and joint problems

  • History of strokes and seizures

  • Family history of aneurysms

  • Hypoglycaemia and Diabetes

  • If you have engaged in fasting over the las 24 hours


If I have a relationship to any of these conditions, and I am unsure as how to/ or whether to practice this technique:


  • I will, inform the facilitator of my condition before the breathwork or message in a private message, and if I am unsure as to whether to practice the mouth breathing form of this practice, or if I am unsure as to whether this practice is appropriate for me at this time. 


  • I will regulate my breath by breathing more slowly, lengthening the exhale, and or breathing in and out through the nose, so that my nervous system is supported during the practice.


  • I also understand that even though I have been accepted as a participant, I am responsible for any consequence resulting from this breathwork session.


  • I understand that Conscious Connected Breathwork is NOT a substitute for consulting my GP or medical care provider. In the event of known medical conditions, I certify that I have consulted a health professional regarding any condition (Physical, mental or emotional) that could interfere with my judgement, or affect my health in any way during or after the session.

 It is also important to create a safe and confidential space for you and others (if in a group setting) so we ask that you agree to keep a confidential space and not share anything which has been shared (aside from your own process) outside of the session. It is also important to create a private space where you will not be disturbed, if working online in the privacy of your own home. Please be mindful of this both for yourself and for others on the online call. Headphones are ideal for this practice as it is offered with musical accompaniment.

  • I acknowledge that the breathwork session is a safe and confidential space, and I therefore agree not to share anything (aside from my own process if needs be)outside of the session.


  • I have read this waiver and by clicking on the link below, I  confirm that I take full responsibility for my own health and wellbeing.

I want to join the Session or webinar,
Sign me up!

Thanks for submitting!

  • Facebook
  • Twitter
  • Instagram
  • LinkedIn
bottom of page