Your Essential Breath Quiz

1

Name

First Name

Last Name

2

Email

example@example.com

3

Date

4

0 Never 1 Sometimes 2 Often 3 Very Often

5

ARE YOU A MOUTH BREATHER OR A NOSE BREATHER

6

Do you talk for a living?

0

1

2

3

7

Type a question

0

2

1

3

8

Do you wake up with a dry mouth or chapped lips?

0

1

2

3

9

Do you have water by your nightstand?

0

1

2

3

10

Do you snore?

0

1

2

3

11

Do you wake up tired?

0

1

2

3

12

Do you have insomnia?

0

1

2

3

13

Do you have frequent colds or congestion?

0

1

2

3

14

Do you have sleep apnea or COPD?

0

1

2

3

15

Do you breathe through your mouth when you exercise or play sports?

0

1

2

3

16

Do you hold your breath or are you unaware of how you breathe?

0

1

2

3

17

TOTAL POINTS