WORK WITH ME Couples session Start by filling out the form below Personal Info First Name:* Last Name:* Your partner’s Name:* E-Mail:* Phone: Delivery:In personVirtual Questionnaire What expectations do you each have for the couple’s breathwork session? What outcomes or changes are you hoping to achieve?* How would you describe the current dynamics of your relationship? Are there specific challenges or areas you’d like to address? Have either of you experienced breathwork before, either individually or as a couple? If yes, please share your experiences.* Are there specific aspects of your relationship or shared goals that you would like to focus on during the session?* Medical If you answer “Yes” to one or more of the following questions below, you must consult your physician before engaging in Breathwork. Tell your physician which questions you answered “Yes” to. After a medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. Select any health conditions below:*Cardiovascular diseaseAnginaHeart attackHigh blood pressureGlaucomaRetinal detachmentOsteoporosisRecent injury or surgeryAny condition for which you take regular medicationHistory of Panic attacks, psychosis, and disturbancesSevere mental illnessSeizure disordersFamily history of aneurysmsFrequent dizziness or vertigoCurrently pregnant Continue to Sheduling *Disclaimer: I am not a doctor. No claims or promises to “heal” you from your condition.
