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Full Name:* This field is required.
First Name
Last Name
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E-mail:* This field is required.
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Phone Number* This field is required.
Country Code
Phone Number or what's app no
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Your Location
Suburb
State
Country
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Have you experienced a guided Breathwork over an hour before ?
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What services are you interested in
Breathwork & Coaching in our Sunshine Coast Studio
Breathwork & Coaching Via Zoom
Group Breathwork at your Venue for your Clients
Breathwork at your company to improve the wellness of your Employees
Key note Speaker / Presenter
Breathwork Facilitator Training
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Do You need Help with any Physical Issues Breathwork can Help
Pain Management
Sleep Issues
Enhanced Immune Function
Respiratory Conditions
Enhanced Physical Performance
Addiction Recovery
Lowered Blood Pressure
Improved Digestion
Breathing Problems like Asthma
nervous twitch
other - u can write below
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Do You need Help with any of the following that Breathwork Improves
Stress Reduction
Improved Mental Clarity
Anxiety and Panic Attacks
Depression
Habit Change
Creativity and Inspiration
Spiritual Growth
Self-Awareness:
Trauma Healing
Self Love
Coping with Grief
Forgivness
Relationship improvement
Letting Go
Other
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What are you are struggling with most in your life right now ? Something you would like to let go of.
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What is one thing would you like to call more of into your life right now ?
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Please tick which journeys you feel called to do
9D Journey - Stress and Anxiety - Great first timers Journey
9D Journey - Letting Go and Moving On
9D Journey Full System Reset
9D Journey - Creating Abundance & Self Trust
9D Journey - Healing Ancestral Lines
9D Journey - Transcending Fear
9D Journey - Healing the Inner Child
9D Journey - From Anger to Freedom
9D Journey - You Are Enough - Overcoming low Self Esteem
9D Journey - Self Love and Forgiveness
The Awakening from social Conditioning
9D Journey - Transcending Fear
The Inception - Break Free from Repetitive Cycles
Releasing Guilt and Shame
Unleash Your Power - Get Motivated to take big action
9D Journey - Releasing and Reframing 5 Main Trauma Imprints
9D Journey - Overcoming Grief and Loss
9D Journey - Return to your Authentic Self - The Origin
The Divine Awakening - Connect to Spirit
Rebirthing Sound Healing - A gentle breathwork with your own inner guidance
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What to expect during a session and how to prepare

Wear loose, comfortable clothes; bring a water bottle,
and writing material to journal after.

We recommend not eating at least 1 hour prior to breathwork 2 hours is ideal.

We supply a thin mattress for you to lie on with bolsters to support your lower back. We provide a light blanket and a thin pillow for under your head to allow the airways to open fully An eye mask is supplied or you can bring your own.

You will be shown special breath techniques with guidance and supported by the coach during your session.

Your body may start to feel electric like your coming alive with energy. This may be all over, or local to one area. This is when the body begins to open up and energy and emotions can move freely through the body, even those emotions that have seemed stuck for lifetimes.

Different Sensations are normal like tingling, buzzing, warming, cooling, or tightness in certain parts of their body. Whatever is happening is supposed to be happening. Your body has an innate intelligence and wisdom and it will support you in releasing what no longer serves you.

Your coach will be there to support and guide you during and after the session

We recommend not driving for 20mins after your session and giving your self some time to slow down process and integrate after your session. Clear your schedule, drink lots of water.
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Do you have any of the following medical conditions ? Currently on heavy medications, severe psychiatric symptoms, bipolar, depression, Osteoporosis, Asthma, experiencing an emotional or spiritual crisis, cardiovascular problems, high heart rate or blood pressure, History of epilepsy or Seizures , history of diagnosed mental health issues. Pregnant. If you have any of these please give a brief details below otherwise just comment with NO in the box below.
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Release of Liability, Waiver and Assumption of Risk AgreementYou authorise Release of Liability, Waiver and Assumption of Risk Agreement In consideration to participating in the Breathwork session conducted by Breathe and Connect. I, hereby acknowledge, understand and expressly agree as to the following: (1) Breathwork can result in intense physical and emotional release Therefore, it is not advised for persons with a history of cardiovascular disease, including angina or heart attack, high blood pressure, use of a pace-maker, glaucoma, retinal detachment, osteoporosis, significant recent physical injuries or surgery. (2) Breathwork is not advised for persons with severe mental illness or seizure disorders or for persons using major medications. It is also unsuitable for anyone with a personal or family history of aneurysms. (3) Pregnant women are advised to let the facilitators know you are pregnant prior to the session so a modified breathing technique can be given. We also recommend consulting and getting approval from their primary care physician. (4) Persons with asthma should bring their inhaler and consult with their primary care physician and the Breathwork class facilitator.
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Thank You for completing the information. Please Book a time for your discovery call if you have not already booked your first breathwork session.
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We look forward to speaking with you soon Ben and Cassy
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