Breathwork Progress Survey Form
Track your breathwork practice and reflect on your progress over time with this simple, structured survey.
How often have you practiced breathwork in the past week?
*
Daily
4-6 times
2-3 times
Once
Not at all
How would you rate your overall progress with your breathwork practice?
*
1
2
3
4
5
How easy or difficult has it been to stay consistent with your breathwork practice?
*
Very Difficult
1
2
3
4
Very Easy
5
1 is Very Difficult, 5 is Very Easy
To what extent have you noticed benefits from your breathwork practice?
*
Not at all
1
2
3
4
A great deal
5
1 is Not at all, 5 is A great deal
Which benefits have you experienced from breathwork? (Select all that apply)
Reduced stress or anxiety
Improved focus or clarity
Better sleep
Increased energy
Greater emotional balance
Other
What has been your biggest challenge with breathwork recently?
Please Select
Staying motivated
Finding time
Remembering to practice
Technique difficulty
Other
How likely are you to continue your breathwork practice over the next month?
*
Not likely
1
2
3
4
Extremely likely
5
1 is Not likely, 5 is Extremely likely
Would you recommend breathwork to others?
*
Yes
No
Not sure
Any additional comments or reflections about your breathwork journey?
Submit Progress
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