Register (post natal) | Fiona McOwan YOGA

Confidential

Post Natal Yoga Registration

Contact Details

Name *

Address *

Home Phone

Mobile Phone

Email *

Birth

Is this your first baby? *

YES

When was your baby born?

What is your baby's name? *

Where was your baby born? *

Please give ages of any other children

Post Natal Health

Please tick (all that apply) if you had

A straightforward vaginal delivery

A tear or episiotomy

An assisted vaginal delivery using forceps

An assisted vaginal delivery using ventouse cup

An elective C-section

An emergency C-section

Please tick (all that apply) if you are having any problems following the birth from:

High/low blood pressure

pelvic girdle pain

back pain

healing from tear or episiotomy

incontinence

problems with C-section scar

prolapse of bladder or bowel

If there is anything else that you think I should know before you start the class please tell me here (e.g. recent or old injury, previous miscarriage, other health difficulties)

Message

General

Have you done Yoga before? *

YES

If yes, please give details:

Do you take part in any of these activities on a regular basis?

Jogging

Cycling

Swimming

Aerobics

Pilates

Keepfit

Tennis

Badminton

Walking