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Meditation in Light

LETS BREATHE TOGETHER

HELP ME TO GE TO KNOW YOU BETTER

I am truly excited about your decision to embark on the journey of discovering
the language of your breath.

To provide you with the best possible support, it's important for me to understand you better. Please take a moment to fill out the form below and return it to me before our first session. This will help us create a meaningful experience
tailored to your needs and your present state of being.
Thank you!

Thank you for taking the time to answer these questions

First Name

Last Name

Email

Birthday

Are you currantly pregnant?

First trimester

Second trimester

Third trimester

Do you have any of these conditions?

High blood pressure

Asthma or other respiratory diseases

Epilepsy

Diagnosed bipolar or schizophrenia

If any of the above point is true for you, would you kindly tell me a bit more about it?

The following questions offer deeper insight into your breathing.
Be aware of the points and collect the total at the end.

Chest pain * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Feeling tensed * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Blurred vision * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Feeling Dizzy * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Feeling Confused * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Fast Breathing * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Feeling short of breath * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Tightness in the chest * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Bloated belly * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Tingeling in the fingers * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Unable to breathe deeply * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Stiffness in fingers and/or arms * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Tightness or cramp feeling around the mouth * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Cold hands and/or feet * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

Palpable strong heartbeat * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

An inner feeling of unrest or restlesness * Required

Never = 0 Points

Rarely = 1 Point

Sometimes = 2 Points

Often = 3 Points

Very Often = 4 Points

What is the total amount of points you got?

Is there anything else you would like me to know about you, which enables me to support you better?

I agree to take full responsibility of my health and well-being during the Breath Work sessions.

Thank you!
Your Email has been sent.
I appreciate your time, honesty and trust in answering these questions. I will go go through your answers and get in touch with you as soon as I can.

SABEL YOGA & WELL-BEING

EMAIL

welcome@sabel-wellbeing.com

PHONE

IN +91 888 98 562 99

CH +41 79 775 35 48

CONTACT

Isabelle Karan

Flame of the Forest Safari Lodge

Kuthwahi village

Kanha National Park, Post Office Rata
Madhya Pradesh – 481768

India

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