Pregnancy WORKSHOP Registration Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Congratulations on joining my FACE TO FACE Workshop
I can't wait to get started...but before we do this registration form must be completed in full prior to commencing any program.

It is your responsibility to provide all relevant information for you safety and to ensure I can provide the best possible service.

Please ensure you have medical clearance to exercise and if any conditions do arise during our program it is your responsibility to advise me of the, plus the treatments and advice you have received from your medical practitioner or carer.

Please complete this form at lease 2 DAYS prior to the start of the workshop.

If you have ordered a MEDICAL GRADE FITBALL on the check out page it will be waiting for you at the workshop.
Please ensure your correct height in cm is provided below so we can provide the correct size and inflated fitball for you.

Please also ensure you have read all terms and conditions here >>https://members.bodyfabulous.com.au/terms-conditions/ prior to signing form below.

Access to the ONLINE CORE CARDIO program will also be provided after workshop attendance.

xx
Dahlas

Any questions reach out to me info@bodyfabulous.com.au

Email *

Your First Name *

Your Surname *

What suburb do you live in ? *

How many weeks / months pregnant are you ?

OR // How many weeks / months postpartum are you ?

Do you have any other children ? Ages ? *

NAME of your Dr / OB or Midwife *

Name of your Physiotherapist (if you have one)

Your occupation (this helps me know your level of activity, stress and postural positions) *

Best phone number I can reach you on : *

Best emergency contact and phone number : *

What is your height ? (for equipment + FITBALL) *

Did you order your own FITBALL on the workshop check out page ? *

YES - and I have confirmed by correct height above

NO - please provide a fitball for me at the workshop

What is your age group - tick 1 box *

19 years or below

20 - 25 years old

26 - 31 years old

32 - 37 years old

38 - 42 years old

43 + years old

Other:

PLEASE CHECK BOX if answer is YES *

Are you carrying more than one baby ?

Is this an IVF / assisted pregnancy ?

Do you have a history of miscarriage ?

Have you had any complications during this pregnancy ?

Have you had any complications during a previous pregnancy ?

Do you have any other children ? What ages ?

Other:

Required

If you answered YES to any of the above please give details below : *

During this PREGNANCY or following delivery POSTPARTUM have you had any of the following ? CHECK BOX FOR YES *

Pelvic Floor / Bladder control issues ?

Diastatis Recti ?

Mild to severe hip pain, pelvic pain or SIJ pain ?

Lower back pain ?

Neck or Shoulder pain ?

Wrist pain or Carpal Tunnel Syndrome ?

Knee or Ankle pain ?

Swelling of hands and feet ?

Gastric Reflux or Severe Morning Sickness ?

Cervical Stitch / incompetent cervix ?

Portion of placenta over cervix ?

C-section ?

Episiotomy / Tears ?

Spotting / Bleeding ?

Depression / Post Natal Depression / Anxiety ?

Breastfeeding concerns / Mastitis ?

Gestational Diabetes ?

Other conditions ?

Other:

Required

If you answered YES to any of the above please give details below : *

Do you have any other medical conditions, allergies etc that are not listed above ? Please give details below : *

Are you taking any medications or supplements? Please give details below : *

Do you exercise regularly ? Give details below about what you do, and what you used to do prior to pregnancy : *

Do you have any other questions or concerns ? *

TERMS & CONDITIONS please read here >> https://members.bodyfabulous.com.au/terms-conditions/ *

I HAVE READ AND ACCEPTED Terms and Conditions

I CONFIRM MY NAME BELOW IS MY DIGITAL SIGNATURE

Required

Dated *

YYYY

NAME / SIGNATURE : *

Thank you ! Please complete your payment process. Then check your inbox for further details x Dahlas www.bodyfabulous.com.au

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of BodyFabulous. Report Abuse

Forms