BreathWork Session Application

Name

Pronouns

Phone

Email

How did you hear about my practice?

What is your experience with breathwork? When was the last time? How often do you practice?

What interests you about breathwork? Check all of the boxes that spark your curiosity. What interests you about breathwork? Check all of the boxes that spark your curiosity. Altered states of consciousness Experience a sense of wholeness Connection to personal power Connection to self love and compassion Connection to creativity and creative expression Explore sexual energy Nervous system regulation Build trust in self Tune in to intuition Spiritual connection

What is your personal intention for this breathwork practice?

The following questions are to help me create the best experience for our time together. My approach to breathwork is trauma informed, pleasure focused, cathartic, expansive and based in meeting you where you are at. Welcoming your whole being and your unique expression. The following questions are to help me create the best experience for our time together. My approach to breathwork is trauma informed, pleasure focused, cathartic, expansive and based in meeting you where you are at. Welcoming your whole being and your unique expression. I agree to do my best and only answer where I feel comfortable

Tell me about your current spiritual, mindfulness or embodiment practice. Frequency?

What is your experience with altered states of consciousness?

Do you have any relevant medical conditions or accessibility needs, you would like me to know about?

I CONSENT I CONSENT By selecting this button I understand that any information I share is private and confidential and will only be used for the purpose of assessment and welcoming me into my practice with Raynefyre.

I AGREE I AGREE By selecting this button, I agree that I am an adult of legal age. This is a co-created experience and I am accountable and responsible for that what is in my domain. This includes understanding consent, my right to body autonomy and agency, expressing my needs, wants, desires, limitations and boundaries.