Breath BodyWork Details

Name

First
Last

Email

Do you smoke?

Yes
No

Do you have any ongoing weakness or injury?

Yes
No

Do you currently have, or have you experienced in the past any ongoing weakness, injury, or operations to the following areas of your body? i.e. feet, ankles, knees, hips, legs, lower back, back, shoulders, neck, arms, hands, wrists, elbows?

Please describe your weakness or injury.

Do you have any other medical/health conditions?

Yes
No

Please select as appropriate.

Are you pregnant?

Yes
No

Please select as appropriate.

Are you in the first trimester?
3 to 6 months?
Over 6 months pregnant?
Post-natal?

Please could you specify any pregnancy related conditions you may be experiencing.

For example: nausea, blood pressure, back ache, dizziness, etc

Personal Information

What is your age group?

Is there anything you particularly need or would like help with during your Breath BodyWork session?

Yes
No

Please give details

What do you hope to achieve from your Singing Holiday?

For example: vocal improvement, increased confidence, relaxation, stress management, increased body awareness, increased lung capacity etc.

Comments

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Breath BodyWork Details

Breath BodyWorks Information

Personal Information