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MumFit Health Screen
In order for you to get the most out of the course in the safest possible way, please answer and return the below questions
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* Indicates required question
Email
*
Your email
I am booking for the course beginning on:
*
MM
/
DD
/
YYYY
Full Name
*
Your answer
Mobile Number
*
Your answer
Have you been cleared for exercise by your Medical Doctor/Women's Health Physio?
*
Yes
No
Please list any injuries (most recent first)
Your answer
Any broken bones or joint replacements?
*
Yes
No
Are you currently on medication? if so, please detail below
Your answer
Do you have impaired hearing or vision?
*
Yes
No
Are you allergic to anything? if so please detail below
Your answer
Do you suffer with high/low blood pressure?
*
No
Low
High
Do you have a heart condition?
*
Your answer
Do you have respiratory issues?
*
Yes
No
Do you have any other relevant condition?
Your answer
Did you have a vaginal or caesarean section birth?
*
Vaginal
Caesarean Section
Before your baby’s birth did you train and if so what type of training?
Your answer
Do you suffer from DRAMS (abdominal separation) ?
*
Yes
No
Don't know
Are you experiencing pelvic floor weakness?
*
Yes
No
Don't know
Are you experiencing symptoms of prolapse (bulging, heavy sensation etc)?
*
Yes
No
Unsure
How old will your baby be when you start the course?
*
Your answer
Will you be bringing baby in car seat/buggy/ travel cot?
Your answer
Are you currently breastfeeding your baby? (relaxin hormone)
*
Yes
No
If there is anything else you feel we should know, please include this here:
Your answer
Where did you hear about MumFit ?
Your answer
Notes
If you have concerns about any aspect of your physical wellbeing since the birth of your baby we would recommend you book in with a Women’s Health Physiotherapist.
Reminder
Don't forget to checkout (complete your payment in your cart) to confirm your place on your chosen course.
Social Media
Throughout the course we may take short video clips where we scan the room to share on Bump Baby and Me / PTI’s social media pages. Please let us know if you have any concerns with this.
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