The Inner Alchemy

Breathwork Specialist

Certification Program

Welcome to the Breathwork Specialist Certification Program!

I’m excited to have you on this transformative journey. Over the next 8 weeks, you'll gain the knowledge and skills needed to become a certified breathwork specialist, deepening your personal growth and your ability to guide others.

To help tailor the program to your unique needs, please complete this intake form. Your responses will help us support your journey effectively.

Thank you for joining us. I’m eager to see the impact you'll create through breathwork.

Let’s get started!

Name

First Name

Last Name

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you hear about this program?

What is your current occupation?

Do you have any previous experience with breathwork or related practices? Please elaborate.

Are you currently a certified professional in any wellness or healing modalities?

Do you have any medical conditions that may affect your participation in this program?

What are your main goals for participating in this certification program?

What specific outcomes do you hope to achieve by the end of the 8 weeks?

Are there any specific areas of breathwork or related practices you are particularly interested in?

Will you be able to commit to all 8 weeks of the program? If no, please explain

Do you have access to a quiet, comfortable space where you can practice breathwork exercises?

Is there anything else you would like us to know before the program begins?

Are you paying in full or using a payment plan?

Paying in Full

Using a Payment Plan

If paying in full, how will you be making your payment?

Cash

Venmo

PayPal (Card)

Zelle

When do you expect to make your payment?