Shamanic Breathwork® Session Application
Hello and thank you for your interest in booking a one-to-one breathwork journey.

Before you embark on breathwork, it's really important that I understand anything that might rise for you during the session, so that I can support you fully.

Please include below any significant physical or mental health issues, including if you are under the care of a medical practitioners, psychiatrists or similar.

I'm excited to receive your application!

- Natalie

Email address *
First Name *
Your answer
Last Name *
Your answer
Contact Number *
Your answer
How did you first learn about my work? (If via recommendation, please give the person's name) *
Your answer
What draws you to Shamanic Breathwork®? *
Your answer
Your Background
Please share any relevant / significant life events, such as: any trauma, abuse or addictions you've experienced and/or recent deaths, break-ups or other emotional stress… *
Your answer
Please list any mental health history, including any psychotic episodes, dissociative experiences, flashbacks, hearing/seeing/sensing things that others can't sense, self harming or suicide attempts. *
Your answer
Any medical conditions or medication you are taking? Please include recent surgery, injuries, anything relating to lungs (including asthma), heart, organs or that restricts your mobility. *
Your answer
Please list any non-prescription drugs, recreational drugs (including marijuana) or psychedelics that you use regularly. *
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Any serious allergies? *
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Please provide a contact name and number in a case of emergency: *
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As someone who has expressed interest in working with me, you will receive my (infrequent) newsletter, Empowered Healing, from which you can unsubscribe at any time.
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