CLIMB Protocol Risk & Emergency Form | Trauma-Informed Safety

Risk & Emergency Contact Form

CLIMB Protocol | Trauma Reset with Real-World Safety

Challenger Point Practice PLLC – Ad Astra Per Aspera

Why This Form Matters

This isn’t your average waiver. The Risk & Emergency Contact Form is how we ensure that every reset—whether in the ocean, hot springs, high desert, or summit—is done with trauma-informed, medically sound, and operationally safe protocols in place.

We’re not asking if you’re perfect. We’re asking how we can keep you alive, regulated, and resilient while we help you reclaim your nervous system.

This form is for anyone entering:

Cold water or hot spring resets
Rolling, crawling, and movement-based trauma drills
Group environments that might trigger panic or withdrawal
Remote field settings with limited immediate care

What This Form Covers

Emergency contact info in case of incident
Health risks like seizures, heart issues, Posttraumatic Stress Injuries, diabetes, or severe anxiety
Known triggers or safety concerns in outdoor or group environments
Medications, medical devices, mobility considerations
Altitude or aquatic concerns
Any personal safety planning we need to be aware of

This is not shared publicly. Only your assigned CLIMB support team (Peer Specialist, Clinical Facilitator, MD/DO if needed) will have access.

Who Sees This?

Only your assigned support team. This includes:

Your Peer Specialist or Coach
The Clinical Facilitator or licensed therapist on your case
Our medical clearance partner (MD/DO) if needed
Emergency services only if a critical incident occurs

Everything follows HIPAA and 42 CFR protections. We’ve got your six.

What If I Have a Condition?

We expect you to. That’s why you’re here.

You can still float with past trauma
You can still do breath work with asthma (we modify everything)
You can still hike even if you’ve been on the couch for a decade
You can still be part of CLIMB with panic history, meds, or medical devices

We just need to know the field risks before we enter the field. That’s it.

We’re Not Here to Exploit You — We’re Here to Watch Your Back

CLIMB is built by first responders, veterans, and trauma clinicians. We know what it feels like to be overexposed and under prepared. This form makes sure we don’t make that mistake with you.

We prep. We train. We check in.

This isn’t therapy in a chair. It’s therapy in the wild. And we respect it accordingly.

Download the Form

📄 [Download 2.3 – Risk & Emergency Contact Form (PDF)]
🖊️ Submit CLIMB Intake Form

Submission Details

You can return this form securely via:

📧 Email: matthew@challenger-point.com
📠 HIPAA-Compliant Fax: 970-360-1011

What Happens Next?

We’ll use this form to:

Prep your Peer Specialist and Clinical Team
Modify your trauma reset track based on safety
Ensure we’re ready if a medical or emotional crisis occurs
Offer the most supportive, ethical, and effective CLIMB experience possible

👣 CLIMB Isn’t Just a Program. It’s a Lifeline.

If you’re reading this, you’re already part of the mission. Complete the form. Let us carry the risk planning so you can carry your story toward strength.

You move—we’ve got you.