Name

Pronouns

Phone

Email

How did you hear about my practice?

Do you have previous experience with breathwork?

Please share more about your breathwork experience, such as how long ago and how often.

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, 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, 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 practice. Frequency?

What is your relationship to self medication, entheogens, psychedelics and other altered states of consciousness?

Tell me about your current relationship to self pleasure and orgasm?

Do you have any relevant allergies, medical conditions or accessibilities I need to know about?

Difficult things from my past or present I want you to know are:

Things I celebrate about my past or present in my journey with becoming whole that want you to know:

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 UNDERSTAND I UNDERSTAND All sessions are consent based and client lead. This means I will be empowered to choose my own adventure. We will create an agreement with intention, and I am responsible for stating my desires, limits and boundaries before each session.

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.