Post Natal Health Screening

Do you currently have any of the following: 

Symphosis Pubis Dysfunction/PGP  

Sacrum or Sacroiliac Pain  

Carpal Tunnel Syndrome 

Knee Pain (side, front or back) 

Upper Back/Neck/Shoulder Pain  



(Urinary or faecal) 


(Uterine, Bladder, Rectum, Vaginal) 

Piles/Haemorrhoids, Varicose Veins/Constipation 

Diastasis Recti

(Separation of the abdominal muscles)  

Bone of joint pain

(Please state location) 

Muscular pain

(Please state location)  

Breathing problems 

Post-natal depression 

I can confirm that I have had the all clear by my GP to commence a suitable post-natal exercise programme. I am aware that I must feel well prior to each session and will notify you (The FFA) should I feel unwell at any time during the workout.

Whilst I am aware that every effort has been taken to ensure this exercise class is suitable for post-natal women, I understand that my participation and safety is my responsibility. I understand that if my baby is with me while working out, that their safety and care is my responsibility.  I understand that it is my responsibility to make sure the area I am working out is safe.

Note: In some cases it may be necessary for you to obtain medical clearance before any form of exercise is commenced – hence it is important to be open and honest when completing this form. IF YOU HAVE ANSWERED YES TO ONE OR MORE QUESTIONS in the section medical history – please talk to your doctor before starting.

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