Breathwork Journey Intake
with Erin Corry
Thank you so much for registering for the upcoming breathwork journey. I'm so excited to have you join me for this transformative experience! Please review below as I want to ensure you have a wonderful experience and that you are fully prepared for the session.
Name
*
First Name
Last Name
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Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Please read & sign & if you have any contraindications, indicate below:
If you have any contraindications mentioned in the waiver, please share information below:
I have read and agree to the conditions above & confirm that I am fit to partake in this breathwork journey. I understand this is legally binding without a physical signature.
I agree
Please read & sign:
I consent to images being taken, understanding that images will not be shared showing anyone in a vulnerable state.
Yes
No
Date
*
-
Month
-
Day
Year
Date
Please share your level of experience with extended breathwork journeys so that I am aware of how to best orient and guide you in the session.
This is my first journey
I've done a couple of journeys but could use a refresher
I'm experienced in breathwork
Where did you hear about this breathwork experience?
*
Instagram
Facebook
Eventbrite
Google
Email newsletter
LinkedIn
Referral/ word of mouth
Island Health
Other
If a referral, please share who referred you:
I agree to receive communication about events from Shift Breathwork Collective
Yes
No
Setting an Intention
I invite you to come with an intention—something you may like to release, let go of, or something that you would like to call into your life. Bringing an intention to your breathwork can invite depth and meaning to your journey. Please reach out to me if you have any questions. I look forward to you breathing with me, fostering release and opening to deeper connection & clarity. Erin x
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