Postnatal Form

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Postnatal Form

This is essential to ensure that we have the most relevant information about your postnatal body. This will help to better understand you and your postnatal needs.

Name *

Email address *

Phone *

Date of most recent delivery *

YYYY

Please provide details of the delivery such as and complications or medications (assisted, C-section, Epidural) *

6-12 week check up with doctor and outcome *

Do any of the following currently apply to you? *

back problems

pelvic floor problems

diastasis (separation of the abdominal wall)

heart problems

undergone surgery in the last 12 months

high blood pressure

low blood pressure

episodes of faintness or diziness

thrombosis or blood clots

bleeding during or after exercising or unexplained bleeding

muscular aches and pains

prolapse (uterine, bladder, rectum, vaginal)

buttock/piriformis pain

sciatica

nerve damage from labour (especially Pudendal)

breastfeeding complications

anaemia or taking iron medication

episiotomy cut, tears or painful perineum

IUD recently fitted

none of the above

Other:

Required

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