Customer Details:
Full Name
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First Name
Last Name
Phone Number
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Format: (000) 000-0000.
E-mail
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example@example.com
What inspired you to try a breathwork session? What are you hoping to get from the session?
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Have you ever experienced a guided breathwork journey before?
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Please confirm the date and time of the Breathwork Journey you wish to book in for
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Breathwork is a safe therapeutic practice but as a precaution, breathwork may not be for you if you have or are experiencing any of the following: Cardiovascular diseases (including prior heart attack), High or abnormal blood pressure or use of prescription blood thinners, History of aneurysms, History of strokes/seizures or other brain/neurological conditions, Epilepsy, Osteoporosis, recent surgery or physical injuries that are not fully healed, Glaucoma, detached retina, Diabetes, Pregnancy, preexisting lung conditions, Severe Asthma (for mild to moderate asthma, please bring your inhaler)On heavy medication, Severe psychiatric symptoms, Schizophrenia, Bipolar, psychosis, paranoia or experiencing an emotional/spiritual crisis. Mental illness who isn’t in treatment or lacks adequate support. It is recommended that if you have any of the above health conditions (or any major health concerns not listed above), that you consult your doctor before participating in a breathwork session, and let me know in advance.
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Disclaimer: I understand that if any of the contraindications are applicable to me (or any major health concerns not listed above), I am obliged to consult a doctor or health care professional prior to participating and to inform the facilitator of this. I understand that Breathwork is an alternative healing modality and should never be used as a substitute for direct medical treatment. I understand that I am fully responsible for my own health and I am participating at my own risk at all times. I understand that I have to be clean of alcohol and substances for at least 24 hours prior to the Breathwork session. Do you agree and are you happy to proceed?
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Yes
No
Is there anything else you feel I should know prior to the session or are there any questions you would like to ask me in advance?
Please let me know if you have any allergies/disliking to incense/sage/essential oils
How did you hear about Mo Chuisle Healing Breath?
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Would you like to hear about future Mo Chuisle breathwork events/offerings via email? (Don't worry I don't spam, one a month or so)
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