Location — Breathe On With Jo | Yoga, Life Coaching, Breathwork in Halifax, Nova Scotia, Canada

IFS INTAKE FORM

Location:
6252 Quinpool Rd
Halifax, NS
B3L1A3

Contact:
jo@yogaon.ca

Intake Form

Name

First Name

Last Name

Email

Phone

(###)

###

####

What are you currently struggling with in your everyday life?

How has your mental health been throughout your life ? Anything of note, please indicate below.

What strategies do you turn to in order to cope, or to feel better? (ex; self care, self soothe, distract, addictions?)