Registration Form | Breathe Easy Co

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Raise Your Vibration Workshop
Order Form

First Name

Last Name

Email

Phone number

Discount Code

Do you have any specific health concerns?

How would you rate your stress level on a scale of 1 - 10, with 10 being extremely stressed. Give any relevant details.

What do you hope to change in your life?

What do you feel is your biggest obstacle keeping you from achieving your health goals?

Please indicate: Quantum Time Release OR Online course. If ordering a QTR, please indicate your preferred time/dates.

Thank you for registering. An email will be sent to you shortly with details.

Contact

Colette Gauvreau

Pickering, ON CANADA

Tel: 416-561-7473

colette@breatheeasyco.org

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