Gamla Healing Breathwork Registration

Dear breather,

I kindly ask you to fill out this form to confirm your participation to the next breathwork session of Gamla Healing. Please read everything carefully and answer each part honestly.

This is to protect all of us!

You will receive an email with the link to the Zoom call shortly before the session.

With love!


Sign in to Google to save your progress. Learn more
Name & Surname *
Email address *
On which day will you attend the breathwork? *
During a Conscious Connected Breath session, we are hyper-oxygenating our body, and that can have various consequences on us. The first effects that you could notice is a dry mouth and/or throat, a headache, and then going further and faster on the journey some tingling, sensations of warmth or cold, many emotions might come up, and even in some cases a physical reaction called tetany. Tetany is a cramping, an involuntary contraction of the muscles that can affect various parts of the body like the hands, the feet, the legs or even the face. That can be quite scary when it happens, but you have to know that it would only last the duration of the breathwork. The tetany will rapidly fade away and the body will gradually return to its normal functioning at the end of the journey. *
A breathwork session doesn't replace in any way a medical or psychological consultation with a physician or licensed healthcare professional. *
A Conscious Connected Breathwork is contraindicated in case of diagnosed pregnancy, schizophrenia, bipolar disorder, high blood pressure, various heart conditions and glaucoma. Please choose one option below. *
If you have been diagnosed with one or more of the mentioned health conditions, please consult your personal physician before taking part in any of my breathwork sessions. To protect your own health, I will request an official medical certificate stating that you are allowed to participate. In any case, the breathing will be adapted to your condition and I will explain you how to proceed in detail.
It is highly contraindicated to participate in a  breathwork session if I you are under the influence of any kind of drug, alcohol included. *
To participate, you need to prepare a space where you can sit, or lay down comfortably without distraction (no noise, no TV, no phone, etc.), with a pillow, a cover, maybe some water, and of course some ear/headphones or speakers to enjoy the musical journey! *
The minutes and hours following the breathwork can be intense and difficult to integrate both physically and psychologically. It is necessary that you feel in the right conditions and environment to go through the process. *
I have read all the above information and know that if I choose to participate in the breathwork, I take full responsibility & legal liability for any effects or consequences that this may or may not have. *
Participating in a breathwork session implies an energy exchange of 10€. You can either send it before or right after the session using PayPal or via wire transfer. *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy