Personal Breath Program Application Form

Name *

Email *

Have you had a Personal Breath Program built by Breath Guidance before?

If Yes, which Breath Guide led your prior Personal Training?

Have you done any other Breath Guidance Programs or Trainings already? If yes, which ones?

Have you done other kinds of breath trainings, programs or practices? If yes, what kinds?

Tell us about your current concerns bringing you to get breath guidance.

Please include any health conditions, lifestyle choices, medications and mental/emotional situations that may influence your ability to breathe your best life.

What's your absolute ideal goal to be obtained from using your breath?

Do you have a preference of Breath Guide to build your personal breath program? If yes, who?

How do you prefer to be contacted?

Email
Phone Call
Text Message
Video Chat

If you prefer contact via phone, please provide your number here.

Is there anything else you want to share?

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