Executive 1:1 Coaching Intake Form

Breathwork Coaching

Executive Breathwork Coaching - Intake Form

← Back

Thank you for your application for the Executive Breathwork Program

Thank you very much for taking the time to submit your intake form, it’s an important part of ensuring that the best experience can be achieved for you. Following receipt and review of your details, you will be contacted with further information. Kind regards, Marlon Quinn

Pre-Session High Performance & Physiological Intake Form

This application will take just a few moments.

To ensure your program is completely customised to your current physiological state, cognitive load, and performance goals, please complete this brief assessment.

Due to the deep, high-touch nature of 1:1 performance coaching, only a limited number of corporate executives and athletes may be accepted into this program at any given time.

All data provided is strictly confidential and used solely for session customisation.

Thank you for taking this time to begin.

Marlon Quinn

Former IT Project & Stakeholder Manager | Oxygen Advantage Coach & Freediver Trainer | Training Leaders & Professionals to Eliminate Burnout, Master Stress Resilience & Optimise Under-Pressure Performance

What is currently your single greatest bottleneck to peak performance, clarity, or leadership?(required)
On a scale of 1-10, what is your average baseline stress level on a typical workday?(required)
Average hours of sleep per night:(required)
Do you wake up feeling refreshed?(required)
Do you utilise any biometric tracking wearables? (eg Garmin Device, Oura Ring, Apple Watch, etc?)(required)
Daily Caffeine / Stimulant Intake:(required)
Do you currently experience any of the following physical symptoms of a dysregulated nervous system?(required)
When you are under acute stress at your desk, what do you notice about your breathing? (Select all that apply):(required)

Because certain breathwork protocols involve changes to intra-thoracic pressure and carbon dioxide retention, please indicate if you have a history of any of the following (Checked means “Yes” / Unchecked indicates “No”):(required)

If you checked Yes to any of the clinical screening items above, your session protocol will be seamlessly modified to gentle, non-cathartic, purely therapeutic down-regulation to ensure absolute safety. In some circumstances a more detailed medical statement may be requested, including Physician Sign-Off.

Acknowledgment:

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge.

Pin It on Pinterest

Share This