APPLICATION FORM
Trauma Informed Breathwork Facilitator, Colonic Hydrotherapist, Nurse & Women's Wellness Coach: In-person & Online.
Firstly, I celebrate you for simply being here and leaning into the curiosity that brought you to this moment. This is the first step to immerse yourself in the personal transformation awaiting. I offer a range of services that consist of in-person containers/sessions as well as potent online journeys.
What you will find within these experiences are a range of breathwork offerings to shift, release and let go of what no longer serves you, mindset/personal development, consultations around how you can detoxify your body and home while improving your health from the inside out, and longer durations of coaching containers that are all inclusive of all the above. I cannot wait to hear and connect with you and I look forward to chatting soon. Love Dayner xx
Full Name
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First Name
Last Name
Address
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Street Address
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Phone Number
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E-mail
example@example.com
Tell me a little bit about yourself. About your childhood, self discovery journey, hobbies, dreams & the things that light you up the most etc
Have you ever journeyed with Breathwork in the past? If so, how was it? What type of breathwork did you do & did you like/dislike it?
Have you ever done any type of Detoxification practice or cleanse? How was it?
What are the biggest challenges you are currently facing right now?
What habits do you no longer want to carry forward? (Thought patterns, lack of confidence, habits, relationships, inner critic etc)
For Detoxification: Do you currently experience any of the following: teeth grinding, rashes, intense cravings, inconsistent bowels, constipation, womb pain, bloating/IBS, nightmares, disrupted sleep, anxiety, depression/low moods etc
Have you had any major surgical procedures/been unwell/or had been on extensive medication for a long time in the last 5 years?
Lastly, if I had the magic potion, what area of your life would you want me to help improve or strengthen the most right now?
Please tick which offering you are interested in:
Online portals will be executed via zoom & support outside of sessions will be utilised with Slack/Whatsapp.
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