Private 1:1 Breathwork & Energy Healing with Akanksha ~ Online ~
Answering this form will enable me to serve you during your potent healing & breathwork journey in the best way I am able to and create a safe, sacred and loving container for you so that you may attract & manifest all that is divinely meant in your highest good, and for the greater good of all ðŸª¬

I offer a combination of energy healing, communicating with your subconscious to release trapped emotions from your body one-by-one, meditation & deep, sacred breathwork to rewire & integrate with the entire journey depending on what I am tuning into for the session

DURATION: 1.5 hours
ENERGY EXCHANGE: INR 5,000/- 

You will receive a whatsapp text or an email from breathpura@gmail.com ~ Kindly keep an eye out in your spam folder as well :)

**Please note that all client information is for my eyes only and kept confidential.
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Email *
Full Name *
Contact Number *
Your Date Of Birth *
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Have you done the conscious connected breathwork before?  *
Are you comfortable with receving energy healing & allowing me to be a proxy for your subconscious to release trapped emotions from your body? *
What intention would you like to set for your journey? What is your 'why'? Why do you feel your soul is seeking this experience? *
What medium/ person did you discover me through? *
Do you have any medical conditions? Recent surgeries?  Medications? If so please share below. *
Are you currently receiving therapy from a  psychologist? If yes, how long has it been since you started? *
Please share info on your sleep quality, perceived stress levels and digestive health. *
On a scale of 1 - 10, 1 being poorest quality and 10 being highest quality, how would you currently rate your mental health? *
Poor quality
Good state
Is there anything else you would like me to know about you and your lifestyle?
Key Information
~  Please don't eat heavy before your session & give a gap of 1.5 - 2 hours if you must eat before
~ Please wear loose, stretchy, comfy clothing. Kindly avoid underwire bras, denims and buttoned trousers
~ Things to keep beside you: light blanket, eye mask, water, journal and pen
~ Please make sure you have zoom on your laptop and bluetooth headphones. Speakers are not recommended
~ Do not drive, operate heavy machinery after the session until you feel fully grounded. This may take some time so please plan accordingly
~ Kindly try and avoid heavy socializing, consumption of alcohol or narcotics for the rest of the day
~ DO try and hydrate more than usual & spend time in nature after your session
Breathwork Release And Waiver
By submitting this form I agree to have read and understood the Breathwork Release And Waiver completely, for this & all future Healing Breathwork experiences with Akanksha & Breathpura
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