Before you come

This short form covers health and safety, and tells me a bit about how you breathe now, in the water and out of it, so I can tailor the clinic to you. It takes about five minutes.

Thanks!
Jenny

Do any of these apply to you? Pregnancy/nursing, epilepsy or seizures, uncontrolled high blood pressure, heart condition or recent heart attack/stroke, asthma, glaucoma, surgery in last 3 months, bipolar/schizophrenia, or meds affecting heart rate or BP

No — none of these apply to me

Yes — one or more applies to me

I'm not sure

About how many hours a week do you train?

Under 2

2 to 4

4 to 6

Do you feel tense during the day?

Never

Sometimes

Often

Very often

Do you get cold hands or feet?

Never

Sometimes

Often

Very often

Do you notice yourself yawning a lot during the day?

Never

Sometimes

Often

Very often

Do you breathe through your mouth at night, or wake up with a dry mouth?

Never

Sometimes

Often

Very often

Do you breathe through your mouth during the day?

Never

Sometimes

Often

Very often

How would you rate your sleep? (1 = poor, 5 = great)

How many strokes do you usually breathe on?

Every 2

Every 3

Mixed

Not sure

Do you hold your breath when your face is in the water?

Yes

Sometimes

Not sure

How easy does breathing feel when you swim? (1 = hard, 5 = easy)

I understand breathwork is a practice, not medical treatment, and that Jenny is not a medical professional. I'm taking part by choice, I'm responsible for my own participation, and I can slow down, sit up, or stop at any point.

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