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 |
Sciatica |
Incontinence (Urinary or faecal) |
Prolapse (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.