Pre Event Questionnaire
Please fill in this form before participating in today's Breathwork workshop.
Thank you!

Nathan & Raechelle
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Neurological: Have you had a brain surgery or do you suffer from a significant head injury, have you ever suffered a stroke or severe migraine?:


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Psychological: Have you ever been diagnosed with bipolar disorder, schizophrenia or previous psychiatric condition? Have you been hospitalised any psychiatric condition or emotional crisis within the last 10 years Or do you have any other medical, psychiatric conditions which would impair or affect ability to engage in any activities that involve intense physical and or emotional release? 

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Cardiovascular: Has your medical practitioner ever told you that you have a heart condition or have you ever had a heart attack, heart surgery, arrhythmias or hypertension?

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Pulmonary: Has your medical practitioner ever told you that you have Pneumothorax, lung disease, emphysema, pulmonary oedema?

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Asthma: Do you have a history of asthma attacks?

(If you are asthmatic, you are welcome to attend providing you bring your inhaler to the session


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Epilepsy: Do you have a history of epilepsy?


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Pregnancy: Are you pregnant or suspect you might be?

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Eyes: Has your medical practitioner ever told you suffer: detached Retina and or Glaucoma?


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Ears: Do you have perforated eardrums, permanent tubes in ear-drums or suffer hearing loss in one or both ears or had ear surgery?


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If you have answer YES to any of the questions above, it is recommended that you have medical clearance from a trusted health practitioner before participating in a Breakthrough Breathwork session. 

We advise you to be responsible for your safety and participation by knowing your body and its limits. If at any stage, you''re feeling uncomfortable, overwhelmed or distressed, you can slow down and rejoin at a rhythm and intensity that you feel comfortable with.

We highly encourage you to trust the process, trust yourself and the power that lies within each breath that you take.   

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Today's event will be photographed by a professional photographer for potential content used for marketing and promotional purposes for Nathan & Raechelle. 

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