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Private Coaching with Akanksha
Answering this form will enable me to feel into whether I will be the best aligned coach for the transformation that you seek and thus create a safe and loving container for you in your highest good
Kindly fill in the details to the best of your ability and I will get back to you via email with further details.
**Please note that all client information is for my eyes only and kept confidential.
Deep love & deep breaths,
Akanksha
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Email
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Record my email address with my response
Full Name
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Your answer
Contact Number
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Your answer
What is your 'why' for being here?
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Your answer
What are the goals that you seek to manifest through this transformation?
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Your answer
What medium/ person did you discover me through?
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Your answer
Do you have any medical conditions? Recent surgeries? Medications? If so please share below.
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Your answer
Have you done embodied breathwork before?
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I'm a first time breather
I've done it a few times
I'm an experienced breather
Are you currently receiving therapy from a psychologist or psychiatrist? If yes, how long has it been since you started?
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Your answer
Please share info on your sleep quality, perceived stress levels and digestive health.
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Your answer
On a scale of 1 - 10, 1 being poorest quality and 10 being highest quality, how would you currently rate your mental health?
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Poor quality
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10
Good state
Is there anything else you would like me to know about you and your lifestyle?
Your answer
Breathwork Release And Waiver
By submitting this form I agree to have read and understood the
Breathwork Release And Waiver
completely.
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