Scope of services
I understand that Sarah Elisabeth, operating under the name Exhale Mom, is a trauma-informed breathwork facilitator and somatic-movement practitioner, not a physician, psychologist, psychotherapist, counselor, or other licensed healthcare provider. Breathwork, somatic practices, visualization, vocal toning, tapping, optional non-clinical supportive touch, and integration coaching are educational and experiential services. They do not diagnose, treat, cure, or prevent any physical or mental-health condition and are not a substitute for medical care, psychotherapy, crisis care, or medication management.
Health disclosure and medical clearance
I confirm that the health information I provide is complete and accurate and agree to notify Sarah Elisabeth before participating if anything changes. I understand Sarah Elisabeth cannot determine my individual medical suitability. If I am pregnant or postpartum, recently injured or ill, recovering from surgery, or living with a medical or psychiatric condition, I will obtain clearance from an appropriate licensed healthcare professional before participating whenever advised or when I am uncertain about safety.
Contraindications
Activated or conscious-connected breathwork may be unsuitable for people with a personal or family history of epilepsy or seizures; cardiovascular disease, angina, heart attack, uncontrolled blood pressure, aneurysm, stroke, glaucoma, retinal detachment, osteoporosis, recent significant injury or surgery, or other serious medical conditions. It may also be unsuitable during pregnancy or early postpartum, or for people experiencing psychosis, mania, active suicidality, a recent psychiatric hospitalization or emotional crisis, or uncontrolled substance use. If any of these apply, or if I am unsure, I agree to disclose this before the session and obtain medical or mental-health clearance. Sarah Elisabeth may decline, pause, or modify a practice for safety.
Possible experiences and risks
I understand breathwork and somatic practices can produce intense physical or emotional experiences. Possible effects include dizziness, lightheadedness, fainting, tingling or numbness, changes in body temperature, muscle cramping or carpopedal spasm, shaking, fatigue, nausea, disorientation, strong emotion, surfacing memories, emotional triggering, or a sense of vulnerability. Known and unknown risks may include physical or psychological discomfort or injury. I voluntarily assume the ordinary risks of participation and agree to communicate symptoms promptly.
Participation and environment
My participation is voluntary. I may slow, modify, pause, or stop at any time, and I will not force or push through pain, panic, dizziness, distress, or a sense that something is wrong. I will not practice activated breathwork while driving, standing, in water, on exercise equipment, near heights, or in another environment where dizziness or altered awareness could create danger. For online sessions, I am responsible for choosing a private, physically safe space and keeping a phone available for emergencies.
Emergencies and crisis support
Exhale Mom does not provide emergency, crisis, or on-call medical or mental-health services. In an emergency, I will call 911 or the emergency service available where I am and seek care at the nearest emergency department. If I am in emotional crisis or at risk of harming myself or another person, I will contact emergency services or an appropriate licensed crisis resource rather than relying on Sarah Elisabeth or Exhale Mom.
No guarantees
The nature of the session has been explained to me, I have had the opportunity to ask questions, and I understand that no result, outcome, cure, or improvement has been promised or guaranteed. I retain responsibility for my choices, wellbeing, follow-up care, and how I use information or practices shared during or after a session.
Assumption of risk and release
To the fullest extent permitted by applicable law, I voluntarily accept the risks of participation and release Sarah Elisabeth and Exhale Mom from claims arising from the ordinary and inherent risks of the services, except to the extent a claim cannot legally be waived. I understand that this paragraph may affect legal rights and that I may consult an attorney before signing.
Privacy and limits
Sarah Elisabeth will treat the information I share as private and use it to support our work, but Exhale Mom is not a medical provider and does not represent that its records are governed by HIPAA. Information may be disclosed when required by law, to respond to an immediate safety concern, to protect rights or safety, or with my authorization. Electronic forms and email carry inherent privacy risks.