BreathWorks Nijmegen Questionnaire

Please click the number in the field of choices that best represents what you have felt recently for each symptom.

0 – Never
1 – Rare
2 – Sometimes
3 – Often
4 – Very Often

Once you submit your questionnaire, your results will be reviewed by a BreathWorks specialist to determine whether you are a good candidate for this program.

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How can we help you today?