Consent Form

Breathe Receive Co. Participation Agreement

If you have any doubts or concerns about participating, please consult your primary care physician first.

For safety reasons, individuals with the following conditions are NOT permitted to participate in Breathwork:

Medical Contraindications:

  • Aneurysms

  • Severe Asthma (If your asthma is not severe, please have your inhaler available during your session)

  • Cardiovascular disease and/or irregularities, including prior heart attack

  • Detached Retina

  • Epilepsy

  • Glaucoma

  • High Blood Pressure that is not controlled with medication

  • History of strokes or seizures

  • Severe Osteoporosis

  • Pregnancy

  • Use of prescription blood thinning or anti-clotting medications (e.g., Coumadin)

Psychiatric Contraindications:

  • Bipolar disorder or schizophrenia (diagnosed by a health professional)

  • Hospitalization for any psychiatric condition or emotional crisis in the past 10 years (e.g., attempted suicide or nervous breakdown)

  • PTSD (please consult with your therapist prior to participating)

  • Any other medical, psychiatric, or physical conditions that could impair or affect your ability to engage in activities involving intense physical and/or emotional release

🧘‍♀️ Conscious Breathwork

Purpose:
Conscious Breathwork is a personal growth experience and should not be regarded as a substitute for psychotherapy or medical treatment. Breathwork can cause specific physiological changes and may lead to intense physical and emotional release.

Potential Effects:
Breathwork can induce specific physiological changes and may lead to intense physical and emotional release.

✨ Reiki Energy Healing

Overview:
Reiki is a gentle yet powerful energy healing practice that restores balance, reduces stress, and promotes relaxation. It is rooted in ancient Japanese traditions and supports the body's natural healing process.

Session Details:
During a session, light touch (with your permission) or hands just above the body are used to help direct energy where it's needed most. Reiki is safe for everyone and integrates well with other holistic practices.

🧠 EVOX Perception Reframing

Overview:
ZYTO EVOX technology helps reframe perception by analyzing your voice and mapping your mindset around key life areas. It uses targeted frequencies to clear energetic blocks, release emotions, and shift subconscious beliefs.

Process:

  • Voice Mapping: Records voice energy as you speak about a topic.

  • Perception Index: Creates a visual of your current mindset.

  • Reframing: Uses guided meditation and frequency feedback to shift perception.

Benefits:
EVOX can assist with emotional balance, health and wellness, relationship improvements, breaking patterns, and enhancing performance and growth.

🧿 AcuDetox / AcuWellness (5-Needle Protocol)

Overview:
AcuDetox, also known as AcuWellness or the 5-Needle Protocol (5NP), is a gentle ear acupuncture technique designed to support emotional, physical, and energetic healing. Developed in the 1970s, it utilizes five specific points on the ear to promote balance and well-being.

Five Ear Points Focus:

  • Kidney: Healing fear, restoring vitality

  • Liver: Detoxification and emotional regulation

  • Lung: Processing grief and strengthening resilience

  • Shen Men: Calming the mind and spirit

  • Sympathetic: Regulating the body's stress response

Benefits:

  • Reduces stress and anxiety

  • Eases withdrawal symptoms

  • Supports trauma and PTSD recovery

  • Improves sleep quality

  • Enhances emotional resilience

  • Strengthens mind-body connection

  • Boosts natural healing processes

  • Accessible and nonverbal

  • Promotes community healing

Session Details:
AcuDetox can be added to any offering—either as a grounding way to begin your experience or as a gentle, integrative way to close it. If needles aren't feeling right for you, ear seeds or beads offer a gentle, non-invasive alternative that still supports energetic flow and balance. However you choose to receive, your comfort and readiness are honored.