Back to Balance

Back to Balance Enquiry Form
Thank you for your interest in Back to Balance.

Because we keep each group to just eight people, we'd love to get to know you a little before offering a place. There are no right or wrong answers. Please answer honestly so we can make sure this programme is the right fit for you.
Full Name:
Email address:
Age (optional)
1. What made you interested in Back to Balance?*
2. Which of these best describes how you're feeling at the moment?

Other
4. What would you most like to get out of the 8 weeks?
5. Have you done anything like this before?
6. Are you currently under the care of a doctor or mental health professional?*
If yes, please tell us a little about it
7. Are you currently experiencing any of the following (This helps us ensure that any breathwork practices are suitable and can be adapted if needed.)
8. Are you currently taking any medication, recreational drugs, or other substances including excessive alcohol that we should be aware of for your safety during the course?*
If yes, please share a little of the detail
9. Are you able to attend every Wednesday evening from 16th September?*
10. Is there anything else you'd like us to know?*
By pressing submit, you agree with the following:

I understand that submitting this form does not guarantee a place on the programme.

I understand that Back to Balance is a personal development programme and is not a replacement for medical or psychological treatment.

I understand I may be contacted to discuss my enquiry before places are offered.

Thank you for taking the time to complete this form. We know that asking for support isn't always easy, and the fact you've taken this first step already says a lot. We'll read every application personally and be in touch as soon as possible.
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Back to Balance Enquiry Form

Thank you for your interest in Back to Balance.