Contact

First name

Last name

Email

Phone

How did you hear about me?

In which city and state do you live?

Have you practiced breathwork before?

Yes

No

Prefer not to say

Is there a specific instance or situation that led you to me today?

What do you hope to get out of our work together?

(It's okay if you aren't sure yet!)

What issues are you currently experiencing in day-to-day life?

Stress

Anxiety

Overwhelm with daily tasks (cleaning, remembering important dates, making phone calls, etc.)

Inability to relax even when I have time to do so

Inability to calm myself when in triggering situations

Prefer not to say

Other

Please check all that apply.

What platform feels most comfortable or accessible to you right now?

In-person

Remote

Are there other services that interest you?

Yoga

Movement Therapy

Meditation

Other

Please check all that apply.

Is there anything else you think I should know?

Your initials here:

Initialing this box means I understand Bree is not a doctor nor practicing psychologist and cannot give diagnoses, write prescriptions, or give medical advice outside the scope of integral breath therapy.

with bree

Need Some Breathing Room?

Address

Hours