Name *

First Name

Last Name

Preferred Contact *

Please indicate your preferred method of contact in case of cancellation

Phone

e-mail

Since having your last child what are you currently experiencing?? *

(please tick those that are affecting you right now)

Have a prolapse (do you have any heaviness or dragging feeling or budge in the vagina?)

Constipation

Lower back pain

General pelvic floor weakness such as leaking urine when coughing, sneezing, laughing or running

Uncontrollably breaking wind

Sensation of heaviness in the pelvic floor

Weakness in your core muscles

Bad posture

Struggle to balance

You have a known tummy separation

Hernia

You get a doming in your tummy when sitting up or in standing

High blood pressure

Depression

Stiff neck and shoulders

Sciatica

Anxiety

Low blood pressure

Piles

No symptoms at all

What fitness classes/workouts do you currently do? *

Please let us know what other fitness classes you are currently doing? Tick all those that are apply to you...

Body to Baby Postnatal Yoga

Online/YouTube fitness classes

Running

Sweaty Mama Classes

One Fit Mama Classes

Legs Bums & Tums Workout

Pilates Classes

Yoga Classes

Mumandmia Classes

Workouts with weights

I currently don't do any fitness classes

How often do you currently attend fitness classes/workouts? *

Once a week

Twice a week

3 to 4 times a week

More than 4 times a week

Every few weeks

Once a month

None

Declaration *

By ticking this box, I am declaring that I have disclosed to my yoga teacher all information regarding my health relevant to the practice of advanced postnatal yoga. I take full responsibility for all applications of yoga I practice in the class and outside the class during. I fully understand that the recommendations, ideas or techniques expressed and described in the virtual advanced postnatal yoga classes cannot be regarded as a substitute for the advice of a qualified medical practitioner. Any uses to which the recommendations, ideas and techniques are put are at my sole discretion and risk.

Tick as signed declaration