Check in:
Thank you for using your time and energy to complete the sheet. This is a great way to check in with yourself, begin to understand how you are feeling and what contributes to that. Each piece of information and personal data that is collected from this sheet is strictly confidential! Please take your time and our Hauora Coach will be in touch with you as soon as possible.
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Email *
What is your name? *
What is the best way to stay in contact with you? *
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Please provide your cell #, FB or IG name if this is your desired contact method:
How are you feeling today?
How many hours did you sleep for last night?
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Have you eaten today?
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Which aspects of YOUR health & well-being are feeling good at the moment? *
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Which aspects of YOUR health & well-being are in need of strengthening at the moment? *
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What are your top worries, troubles or struggles at present? *
What is your intention for the 1:1 session that you have booked? *
Why is wellness important to you right now? *
What type of help are you seeking *
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Please share any dis-ease in your mind, body and soul space. This will help guide take away material. *
Please list below any and all medications you take: *
Please list any and all supplements. As well as the times taken per day. *
Take 3 deep breaths and fill out below your ideal outcome. (Eg, easy to fall asleep & waking with energy, a dedicated daily practice that feels fun & free, change in career & saving for a family) *
What is your experience with meditation, breath-work and movement? *
Terms & Conditions

I represent and warrant that I am in good physical health and do not suffer from any medical condition(s) that would limit my participation in classes/workshops/services offered by Astiana Trouland. I understand that it’s my responsibility to consult with a physician prior to and regarding my participation in any of the classes/workshops/services offered by Astiana Trouland and I agree to follow all instructions so that I can participate safely. I acknowledge that my participation exposes me to possible risks of personal injury. I am fully aware of these risks and hereby release Astiana Trouland from any and all liability, negligence, or other claims arising from, or in any way connected with my participation in their classes/workshops/services offered by them. I have read the above release and waiver of liability and fully understand its content. By checking the box below I confirm that I am legally competent to accept these terms and voluntarily agree to the terms and conditions above. Please practice mindfully and enjoy the benefits of what Astiana Trouland has to offer.

As is the case with any physical activity, the risk of injury, even serious disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will acknowledge my physical limitations, discontinue the activity, and ask for support from the facilitator. I assume full responsibility for any and all damages, which may incur through participation.
There are contraindications, in which, I have been made aware. I will report to the facilitator any medical conditions or physical limitations before the session. I confirm that I am not pregnant, nor have severe asthma, severe heart disease, a mental illness, epilepsy/history of seizures, acute physical injuries or severe diabetes. I am not intoxicated by alcohol or drugs.
I also affirm that I alone am responsible for deciding whether to participate in a these session and that participation is at my own risk. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against my breathing facilitator.
I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law.

Cancellation Policy
We have a no refund policy for classes and workshops. If you cannot make the class or workshop, you are able to pass the ticket onto a friend, please let us know if you are passing the ticket to someone and who that person is. With 24 hours notice you will receive a credit to go towards a future event.
If we have to cancel/postpone an event due to lockdown levels we will offer a credit to be used at another event in the future or 1 on 1 session.

Photographs and video are taken throughout our events to share with others what we offer so that we can be of greater service to humanity. Please let us know if you do NOT want your photograph taken prior to the event.

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