Breathe : Feel : Flow
1:1 Presencing Session For Women & Men - Online - Registration Form.
Please take your time and pace to respond to the questions in this form.
Once you have submitted, you will hear from me in 24 - 48 hours time frame.
Meantime you can reach out to me 91-9900093692
Name *
Email *
Phone no. *
Country & City *
Age *
Gender *
What calls you to do these sessions? *
Be as elaborate as you can in your response, take your time to share from your heart.
Tell me about yourself? Who you are a person? *
Be as elaborate as you can in your response, take your time to share from your heart.
What are the feelings that you are comfortable with? Name top 3 atleast. *
What feelings are discomforting/ unbearable/ unknown/unfamiliar? *
How would you describe your body presently? *
Do you have any existing medically diagnosed condition - physically, emotionally, psychologically? *
Do you take any prescribed drugs at the moment or in the past? *
Do you consume psychedelics or any other kind of perception altering drug? *
Have you undergone counseling, psychotherapy or any other form of therapy? If yes - What was the issue? What is/was the duration? *
Do you have something more on your mind that you would like to share with me? *
What expectations do you have from these sessions? What change do you want for yourself through these sessions? *
How did you come to know about these sessions? *
Can you commit to 3 months, every week, and even more in between to stay with these sessions? *
Do you have any questions for me? *
Contribution *
These sessions are offered at an Introductory Price of 500 INR/- per session or USD $7. If you strongly feels called to take these sessions and find yourself financially stressed, please contact, nobody will be turned away due to lack of funds. The intention of the pricing is to be inclusive to people across geographies, culture, gender, and economic spectrum. If you feel that you receive something of deep value, you can make a larger financial contribution to support the facilitator, please do so. The facilitator is a freelancer and rely upon the generosity of the larger community for supporting the work and making it financially sustainable. I invite you to be creative and think about how to rebuild the trust and a mutual care economy. Reach me on:
Payment Guidelines & Acknowledgements
Payments can be made anytime within 1 week before or after the session. One session is 60 mins priced at 500INR At times we may go over the time, to account for the extra time, the price changes. For every extra 30 mins, adds 250 INR per 30 mins. So when you make the payment please account for the time and pay accordingly. Once you make the payment, please drop me a message or email. I will acknowledge the payment.
Participant Consent *
I understand that this workshop involves experiential processes and I am willing to participate taking complete responsibility for myself.
I am participating in this sessions at my own risk and with my own free will. I take full responsibility for participating in this program. I release all Instructors, Organisers and assistants of this course from all damage whatsoever and waive all rights to compensate in case of any injury. I declare that I am physically, emotionally and mentally able to participate in this course and will keep confidential the matter and the proceedings. (submitting this form will mean that you agree with the above declaration).
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy