CoreBalance Breathing Health & Disclaimer Form

Please fill out this form as best you can so we can provide you with the best support.

Contact Information

Personal Details

Medical Background

Symptoms

Please indicate any of the symptoms that you experience in the list below. It is not uncommon to tick quite a few here.

For Women

Signs and Symptoms that can be associated with breathing dysfunction.

Physical Activity

Eating Habits

Please list your food intake for two specific days over the last week, including 1 weekday and 1 weekend day.

Disclaimer

Please read the following disclaimer carefully before signing, and/or seek professional legal advice if necessary.

I understand that Anne Corbett is not a registered medical practitioner nor is anyone else at Oxygen Research Institute Ltd. No advice and activity presented, demonstrated or advised during the Course are in any way intended as a substitute for medical consultation, and should not replace or interfere with any guidance offered by a medical professional.   

If at any time during breathing sessions, I feel the need for any assistance, medical or otherwise, I agree to notify Anne Corbett immediately and take full responsibility to obtain appropriate care.  

I understand I will need to inform Anne about my pregnancy status, before starting the session training and exercises. If I become pregnant or believe I may be pregnant after starting, I agree to stop all exercises  and inform Anne to guide me on the next course of action. 

I hereby confirm that I have carefully read this disclaimer and have fully understood that this is a release of liability.