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To finalize your registration, please fill out the medical form below.

Health Information

Grof Breathwork and psychedelic therapy are intended for personal growth. This can involve experiences accompanied by emotional and physical release. Therefore, it may not be suitable with certain medical conditions.

If you have any doubt about whether you should participate, don’t hesitate to ask us, or consider consulting your physician or therapist. The answers to the following questions are for us to create a safe space for you and will be kept strictly confidential and deleted after the event.

Cardiovascular disease, including heart attacks & strokes *
High blood pressure (not regulated) *
Physical injuries, including fractures or dislocations *
Recent surgery *
Recent or current infectious or communicable diseases *
Glaucoma *
Retinal detachment *
Epilepsy *
Asthma (If yes, please bring your inhaler to the workshop) *
Osteoporosis *
Severe mental illness *
Are you currently pregnant? *
Have you ever been hospitalized for medical reasons? *
Have you ever been psychiatrically hospitalized? *
Are you currently in therapy or involved in any type of support groups? *
Are you currently taking any type of medication? *
Any severe accidents, incidents or abuse issues, we should know about? *
Any problems around your birth? *
Is there anything else about your physical or emotional status we should be aware of? *