Do you current or have you ever suffered any of the following conditions? IF YES PLEASE SELECT.

    Symphysis Pubis Dysfunction (pain in the central pubic area)Sacrum or Sacroiliac Joint Pain (pain in the exceptionally low mid back – top of buttocks)Bleeding during or after exercise or any unexplained bleedingCarpal Tunnel Syndrome (Wrist/finger/hand forearm -pain/numbness or tingling)Knee Pain (Side/front)High/low blood pressure, episodes of faintness, dizziness or breathlessness, history of Thrombosis or blood clotsUpper Back/Neck/Shoulder PainCoccyx Damage or PainDiastasis (Separation of your abdominal muscles)Lack of total Bladder/Bowel Control (Urinary or Feacal Incontinence)Prolapse (Uterine, Bladder, Rectum, Vaginal)Breast Health/Breast Feeding IssuesPiles/Haemorrhoids/Varicose Veins/ ConstipationWere you given an Epidural during birthing?Nerve Damage During Birthing (Especially Pudendal)After Effects of Gestational DiabetesC-Section wound discomfort or slow healing or ongoing numbnessAnaemia or taking Iron medicationJoint PainButtock/Piriformis Pain/SciaticaEpisiotomy Cut, Painful Perineum or Tears (Degree if known)

    Is there anything in your medical history you feel could affect your ability to exercise?

    Are you taking any medication? (Please give details)

    Is there anything about your pregnancy or birth that you feel is relevant to the participation in an exercise programme?

    What are your goals or reasons for participating in exercise?

    Type of delivery?

    Are you breastfeeding?

    Are you getting up at night?

    How much sleep are you getting?

    Are you doing any other exercise now?

    What Previous exercise did you do before pregnancy?

    COVID - Please select YES or NO to the following questions:

    Have you been in contact with anyone displaying signs or symptoms of illness or COVID-19 in the last two weeks? *
    YesNo

    Have you displayed any signs and symptoms of illness or COVID-19 in the last two weeks? *
    YesNo

    Have you travelled outside your home region in the last two weeks? *
    YesNo

    Have you had your vaccines? *
    YesNo

    Data Protection: The information you provided in this form will be used for fitmums purpose only, by your instructor and will not be shared with any third party without your prior permission. It will be stored for 5 years on your trainers’ private computer.

    By submitting this form, you agree to the following:

    I am aware that I must feel well prior to each class and will notify you (the trainer) should I feel unwell at any time during the class.

    Whilst I am aware that every effort has been taken to ensure this exercise class is suitable for postnatal women I understand that my participation and the safety of both my child/children and myself are my responsibility.