Please complete this form before attending any Breath and Beyond session. All information is treated as strictly confidential.
Conscious Connected Breathwork is a breathing technique that focuses on a continuous breathing pattern. The technique requires breathers to inhale and exhale through a wide-open mouth whilst lying down, preferably with their eyes closed.
Throughout the session you will be encouraged to delve into your internal landscape through verbal cues and physical touch. This may be a hand placed on your chest, stomach, shoulders or head. Should you wish to opt out of any physical touch, please indicate below or speak directly with Tilly.
🔒 All information provided on this form is treated as strictly confidential and used solely to ensure your safety during your session. Please read our Privacy Policy for full details of how your information is stored and handled.
Personal Details
Please complete all sections. All information will be treated as confidential.
Medical Information
Please answer the following questions honestly. This information is essential for your safety during the session.
Do you have any of the following conditions? Please tick all that apply.
Breathwork Experience and Session Goals
Consent and Medical Waiver
Conscious Connected Breathwork is a powerful technique that may involve intense physical and emotional experiences. It is not a substitute for medical or psychological treatment. If you have any doubts regarding your ability to participate safely, please consult a qualified medical professional before attending.
By submitting this form, I confirm that:
I have read and understood the information provided about Conscious Connected Breathwork.
I have disclosed all relevant medical conditions above.
I accept full responsibility for my physical and mental health during the session.
I understand that I may stop my participation at any time.
I release the facilitator and venue from any liability for injuries or health issues arising during or after the session, except where caused by negligence.
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Registration submitted successfully. Thank you. Tilly will be in touch shortly to confirm your session details.
If you have any questions or concerns, please contact Tilly before attending at breathandbeyond25@gmail.com or 07725 363098.