Fill in this form before the first meeting with your Buteyko Breathing instructor.
When we receive the form we'll get in touch with you to setup the initial appointment via Skype or telephone.
Please fill in the name and email of your Advanced Buteyko Instructor (optional)
Please tell us how you want us to contact you. Should we use telephone, skype or email?
Have you ever suffered from the following conditions and diseases? Do you suffer from them now? Please give full details below. For diseases you never suffered from, just leave the field empty.