Post Natal Medical and lifestyle questionnaire
Please state location of preferred class?i.e. West Norwood / Beckenham etc
Date of Delivery / Due date
Type of delivery (Assisted, Vaginal, C-Section):
which service /class I am interested in
Emergency contact number
6-8 Week Check-Up Outcome
Post Natal Bleeding Status
Please give details of your Pregnancy & Post Natal, include any complications, illnesses, reasons to visit your Doctor or any other Health Practitioner including Massage, Acupuncture, Pilates, Physiotherapy, Osteopathy, Chiropractor etc
Do you current or have you ever suffered any of the following conditions? Please circle if YES
If you have answered yes to any of the above questions, please give further details
Is there anything else in your medical history that could affect your capacity to exercise?
Are you on any medication? If so please give details
I confirm that I understand that participation in this group is entirely at my own risk and that should I have my baby with me in any of the classes I take full responsibility for my own child.
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