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SELF-ASSESSMENT

We invite you to explore the relationship between your breathing habits and your health. Submit for a free 20 min consultation (virtual or by phone) to answer your questions and to determine if a full assessment is warranted.

Breathing Behaviors Self-Assessment
EVERY HABIT HAS AN ORIGIN Answers to the following questions are important to learning about the HISTORY of your breathing habits. Please check all that apply to you.
SUCCESSFUL BREATHING HABITS ADAPT AND GENERALIZE Sometimes they succeed in optimizing physiology; sometimes they succeed in optimizing psychology, at the expense of physiology. Please check all of the below circumstances in which you experience symptoms.

Please rate the prevalence of the symptoms below on a scale from 1-5, 1 being "not at all" and 5 being "daily".

(01) Chest tightness, pressure, or pain
(02) Intentional breathing, purposeful regulation
(03) Dizziness, light-headedness, fainting
(04) Shortness of breath, difficulty breathing
(05) Tingling or numbness, e.g., fingers, lips
(06) Unable to breathe deeply
(07) Not exhaling completely, aborting the exhale
(08) Deep breathing, like during talking
(09) Chest breathing, effortful breathing
(10) Breath holding, irregular breathing
(11) Rapid breathing, panicky breathing
(12) Worried about my breathing
(13) Mouth breathing
(14) Can’t seem to get enough oxygen

Thanks for submitting! We will reach out to schedule a consultation shortly.

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