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UNTAMED Intake Form

This takes about 2 minutes. It helps Diego understand your body, your experience level, and how to keep you safe. All information is confidential.

About you

Experience and health

Emergency contact

Consent and agreement

I understand that breathwork and cold exposure can be physically and emotionally intense, and may involve risks such as dizziness, emotional release, changes in blood pressure, or discomfort. I agree to follow all guidance from my facilitator and to listen to my own limits. I confirm that I will not participate if I feel unwell, under the influence of alcohol or drugs, or if I have been advised by a medical professional to avoid intense breathwork or cold exposure. I agree to release and hold harmless Breathflow Connection, its facilitators and partners from liability for personal injury or property loss arising from my participation, except where not permitted by law.

Your information is confidential and seen only by your facilitator.

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