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Before we can take the next step and you can book an appointment with me. I please ask
that you fill out this short pre-waiver form as a sign of your interest and commitment to making a change in your life and your dedication to working with me on your healing journey.

Pre-Waiver Form

Which session are you interested in booking?


Activation breathwork and Kundalini Bodywork is not recommended for people with:

A personal or family history of epilepsy

Active addiction, severe psychiatric symptoms including active personality disorders and mental illness


Cardiovascular problems including angina or heart attacks

High blood pressure



Retinal detachment


Recent physical injuries, surgery or illness (particularly involving the mouth, teeth, nose, throat, thyroid, immune system, lymphatic system, lungs, chest, ribs, spine and reproductive organs)

Thanks for submitting!

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