VIP Container Application – BREATHE
Thank you for your interest in a VIP container. These experiences are intentionally designed and application-only to ensure alignment, readiness, and care. Please answer honestly and thoughtfully. Not all applications are accepted.
Please answer honestly and thoughtfully. Not all applications are accepted.
🧩 SECTION 1: BASIC INFORMATION
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Time Zone
*
Please Select
Eastern
Central
Mountain
Pacific
Other
Preferred Method of Contact
*
Please Select
Email
Phone
Text
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VIP Container Application BREATHE
🧩 SECTION 2: INTENTION & ORIENTATION
What led you to apply for a VIP container at this time?
*
What are you hoping to experience more of through consistent guided support?
*
calm, clarity, steadiness, grounding, emotional regulation
What feels most challenging for you right now?
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VIP Container Application BREATHE
🧩 SECTION 3: READINESS & SAFETY (CRITICAL)
How would you describe your current emotional state?
*
Generally stable, but carrying stress or emotional weight
Managing well, seeking deeper support
Feeling overwhelmed, but still functioning
Currently in crisis or emotional distress
Are you currently experiencing thoughts of self-harm or suicide?
*
Yes
No
Are you currently under the care of a licensed mental health professional?
*
Yes
No
Are you seeking this container as a replacement for therapy or medical care?
*
Yes
No
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VIP Container Application BREATHE
🧩 SECTION 4: EXPERIENCE & ALIGNMENT
Have you participated in BREATHE: The Healing Circle or other guided experiences with Crystal?
*
Yes
No
Which type of support are you most drawn to right now?
*
Small group support with guidance
A blend of group and private sessions
Fully private, one-to-one support
Unsure — open to guidance
What draws you to this style of work (breathwork, Pranic techniques, guided relaxation)?
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VIP Container Application BREATHE
🧩 SECTION 5: COMMITMENT & LOGISTICS
VIP containers require consistency and personal responsibility. Does this feel realistic for you right now?
*
Yes
I think so
Not at this time
Are you able to create a quiet, uninterrupted space for sessions?
*
Yes
Sometimes
No
If accepted, are you prepared to make the required investment or complete a Healing Reservation Plan before sessions begin?
*
Yes
Possibly — I’d like to discuss options
No
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VIP Container Application BREATHE
🧩 SECTION 6: CONSENT & AGREEMENT
Acknowledgment
*
I understand this is a complementary wellness experience and not psychotherapy, medical treatment, or crisis support.
Responsibility& Boundaries
*
I understand participation requires emotional readiness, personal responsibility, and respect for boundaries.
Application Review
*
I understand that acceptance is not guaranteed and is based on alignment and availability.
🧩 SECTION 7: FINAL QUESTION
Is there anything else you’d like me to know as I review your application?
Submit
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