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Optimising Performance - Breathwork

Medical Questionnaire and Waiver - June 23, 2026

Led by Dr Clare Nieland and Ben Bidwell, the evening will combine expert insight with practical experience. Alongside the guided breathwork session, there will be an opportunity to examine the evidence behind these approaches and consider how they may be applied in both professional and personal life.
A few practical notes:
- Please wear comfortable clothing that allows you to relax and breathe freely.
- We recommend avoiding a heavy meal immediately before the session.
- Water will be available throughout the evening.
- Yoga mats and all equipment required for the breathwork practice will be provided. - Light refreshments will be served following the session.
To ensure your session is both powerful and safe, please take a few minutes to complete this form.
All responses are confidential.

Your name

Emergency Contact

In the unlikely event of an emergency during the session, please provide the details of someone we can contact on your behalf.

Emergency contact name

Emergency contact phone number

Their relationship to you

About the Session

This breathwork experience is designed to be a safe, beneficial, and transformative practice. You are always in control of your experience and are encouraged to breathe at your own pace. Some breathwork practices may produce physical sensations or emotional releases and aren’t right for everyone. It is essential that you take full responsibility for your own health and wellbeing; please read the information below.

Previous Breathwork Experience

Have you done breathwork before?

A
B

Data and Privacy

The health information you provide in the following section is special category data under UK data protection law. London Venture Club will use it solely to ensure your safe participation in this breathwork session. It will be shared only with the event facilitators and deleted securely within 90 days of the event.

Please confirm your consent to data processing

Medical Questionnaire

The following questions are about your current health. While participants are always encouraged to listen to their bodies and breathe at their own pace, if you have any of these conditions or are uncertain about participating fully, I recommend consulting a healthcare provider and letting us know in advance.

Do you have severe or uncontrolled high blood pressure, or any cardiovascular issues (such as heart disease, arrhythmias, or recent heart surgery)?

A
B

Are you pregnant, or do you have epilepsy, a history of seizures, or a severe mental health condition (such as schizophrenia or bipolar disorder)?

A
B

Do you have a chronic respiratory condition (such as COPD or severe asthma)?

A
B

Do you have a pacemaker?

A
B

Do you have any other health issues, medications, or physical limitations we should be aware of?

A
B

About You

Are you experiencing any major life shifts, challenges, or transitions that we should know about at the moment?

This information helps our facilitators understand any factors that may be relevant to your experience during the session. All information will be treated confidentially.

Waiver Agreement

By submitting this form, you confirm that:
- You have read and understood the potential risks and contraindications.
- You are participating voluntarily and take full responsibility for your health during and after the session.
- You agree to disclose any relevant medical conditions or concerns.
- You release Ben Bidwell, Hooke and London Venture Club from any liability related to your participation in this breathwork session.

Please confirm you have read and agree to this waiver