Breathing Exercises Checklist
Track your daily breathing exercises and assess your experience.
Full Name
*
First Name
Last Name
Date of Exercise
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Which breathing exercises did you perform today?
*
Diaphragmatic Breathing
Box Breathing
Alternate Nostril Breathing
Pursed Lip Breathing
4-7-8 Breathing
Resonant Breathing
Other
How many minutes did you spend on breathing exercises today?
*
How would you rate the overall difficulty of your breathing exercises today?
*
Very Easy
1
2
3
4
Very Difficult
5
1 is Very Easy, 5 is Very Difficult
How beneficial did you find today's breathing exercises?
*
Not Beneficial
1
2
3
4
Very Beneficial
5
1 is Not Beneficial, 5 is Very Beneficial
Did you experience any challenges or discomfort during the exercises?
*
No
Yes (please describe below)
If yes, please describe the challenges or discomfort you experienced.
Would you like to set a goal for tomorrow's practice?
*
Yes
No
If yes, please specify your goal for tomorrow's breathing exercises.
Additional comments or feedback
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