Registration for Breathwork

Breathwork with Monika Branat

Full Name:*

Mobile including country code:*

D.O.B*

Email:*

example@example.com

Home Address :*

What is your profession? Does your work fulfill you?

How did you hear about me?

What kind of health (physical/mental) issues are you experiencing currently?

Previous experience with breathwork:

Is there anything else you would like me to be aware of:

Conscious connected breathwork has contraindications to be aware of. If you have health concerns, please let me know. If any of these health conditions apply to you, or you have other concerns, please speak with your doctor prior to practicing. Contraindications may include: delicate pregnancy, epilepsy, eye conditions including glaucoma, detached retina, or recent eye surgery. Heart conditions, thyroid conditions, uncontrolled high blood pressure, diabetes. Aneurysms (head, stomach) and other vascular conditions. Diagnosis of bipolar or schizophrenia. If you are on heavy medications, or after an operation.

Cancellation policy: Cancellations are possible 48 hours before the event. If it is cancelled within 48 hours I wont be able to reimburse you.

I confirm that I am aware of the contraindications to practicing conscious connected breathing and the cancellation policy.

Yes

Price: 35 EUR

Before the session you are requested to pay the agreed fee by bank transfer:

KBC Bank: BE31 7340 2554 4755

Date:*

Signature