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Client Registration Form

Completion of this form is required before attending your first session. Your information is held in strict confidence and is used solely to support your attendance. 

Breathwork can involve physical, emotional, and physiological responses. Please answer honestly.

If you have any questions or concerns before completing this form, feel free to get in touch

(contact information at the end of the form).

Acknowledgement & Consent

Please read carefully before confirming.

By completing this form you confirm that the information you have provided is accurate and complete to the best of your knowledge. You understand that breathwork is not a substitute for medical or psychological treatment. You confirm that you are participating voluntarily and undertake the course at your own risk, accepting full responsibility for your physical, mental, and emotional wellbeing during and after the course. You agree to inform the facilitator of any changes to your health prior to the course commencing.

For in-person sessions, all required equipment is provide for you; mat, blankets, cushions.

You may wish to bring along your own blanket too.

For 2-hour Shamanic Sessions, I highly recommend fasting (both food and liquids) for at least 2 hours prior to the start time.

 

To fully support your integration, I also suggest refraining from or curtailing social media, alcohol, and other stimulants or intoxicants for at least 24 hours before and after the session. This space allows the peaceful energy and harmonious emptiness you create to be filled with goodness and positive vitality.

How would you describe your level of stress currently?
Do you currently have, or have you ever had, any of the following? (Please tick all that apply and provide details where relevant)
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