Consent, Health Disclosure & Release of Liability

To be completed before your Somatic Breathwork and/or Reiki session

1. Nature of the Session

I understand that ANAMI Healing LLC offers Somatic Breathwork facilitation and Holy Fire® Reiki energy healing. I understand these are complementary and holistic wellness practices, not medical, psychological, or psychiatric treatment, and that Gayatri Bahl is not a licensed physician, therapist, psychologist, or mental health counselor. These sessions are not a substitute for diagnosis, treatment, or advice from a qualified medical or mental health professional.

2. Health & Contraindications Disclosure

I confirm that I have disclosed to the best of my knowledge any of the following that apply to me:

• Pregnancy

• Cardiovascular conditions (including high/low blood pressure, heart disease, history of stroke or aneurysm)

• Respiratory conditions (including asthma, COPD)

• Epilepsy or seizure disorders

• Glaucoma or detached retina

• Severe mental illness, psychosis, or dissociative disorders

• History of panic attacks, PTSD, or trauma that may be activated by intense breathing or emotional release

• Recent surgery, injury, or physical limitation

• Current use of psychiatric medication, or recreational drug/alcohol use in the past 24 hours

I understand that Somatic Breathwork can involve intense physical sensations, changes in consciousness, emotional release, tingling, lightheadedness, or (rarely) fainting, and that these are known possible effects of the practice.

I understand it is my sole responsibility to disclose relevant health conditions, and that withholding this information may increase my risk.

3. Voluntary Participation & Right to Stop

I understand participation is voluntary. I may modify my breath, rest, or stop at any point during the session for any reason, and I am responsible for listening to my own body and communicating my needs to the facilitator.

4. Assumption of Risk

I understand that, as with any wellness or somatic practice, there are inherent risks including but not limited to physical discomfort, emotional distress, dizziness, or re-emergence of past trauma. I voluntarily assume all such risks.

5. Release of Liability

In consideration of being permitted to participate, I, on behalf of myself, my heirs, and assigns, release and hold harmless ANAMI Healing LLC, Gayatri Bahl, and any affiliated practitioners from any and all claims, liabilities, damages, or costs arising from my participation in this session, except to the extent caused by gross negligence or willful misconduct.

6. Confidentiality

I understand that anything shared during the session will be held with care and discretion, though ANAMI Healing LLC is not a licensed clinical provider and this is not a legally privileged or clinically confidential relationship (e.g., not HIPAA-protected).

7. Emergency Acknowledgment

I understand that if I am in psychiatric or medical crisis, this session is not an appropriate substitute for emergency care, and I should contact 911 or a licensed provider instead.

8. Consent

By checking the box below and submitting this form, I confirm that:

• I have read and understood the above

• I am voluntarily choosing to participate

• I am 18 years of age or older (or have guardian consent)

• I release ANAMI Healing LLC and Gayatri Bahl from liability as described above