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Nijmegen Questionnaire

This the Nijmegen Questionnaire for Dysfunctional Breathing — a validated questionnaire created by Jan van Dixhoorn.


​If you have questions about this or your breathing, please email Jennifer.

Answer these 16 questions considering how you have felt over the past month or so.


0 - Never

1 - Rarely

2 - Sometimes

3 - Often

4 - Very Often

1. How often do you experience chest pain?
0
1
2
3
4
2. How often do you feel tense?
0
1
2
3
4
3. How often do you have blurred vision?
0
1
2
3
4
4. How often do you feel dizzy?
0
1
2
3
4
5. How often do you feel confused?
0
1
2
3
4
6. How often do you have faster & deeper breathing?
0
1
2
3
4
7. How often do you feel short of breath?
0
1
2
3
4
8. How often do you have tight feelings in your chest?
0
1
2
3
4
9. How often do you have a bloated feeling in your stomach?
0
1
2
3
4
10. How often do you have tingling fingers?
0
1
2
3
4
11. How often do you feel unable to breathe deeply?
0
1
2
3
4
12. How often do you have stiff fingers or arms?
0
1
2
3
4
13. How often do you have tight feelings around your mouth?
0
1
2
3
4
14. How often do you have cold hands or feet?
0
1
2
3
4
15. How often do you have palpitations?
0
1
2
3
4
16. How often do you have feelings of anxiety?
0
1
2
3
4
Would you like Jennifer to email you with more information regarding your results and upcoming breath retraining courses?
Yes, Please
No, Thank You
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