Mummy MOT pre screening
Please answer the questions below as best you can, there is space at the end for more information.
Name
First Name
Last Name
Email
example@example.com
How many weeks post natal are you?
Have you had your 6 week check?
Do you have any medical problems
Are you on any medication
What concerns are you experiencing since giving birth?
Did you have any problems/conditions before pregnancy
Did you have any complications during pregnancy?
Have you underdone any gynaecological surgery?
Have you ever suffered from any bowel conditions such as IBS, colitis etc?
Are you breastfeeding?
Have you ever been diagnosed with SPD, SI joint pain or PGP?
Are you hypermobile (BHMS or EDS)?
Have you developed excessive stretch marks during pregnancy?
Have you developed diastasis (tummy gap)
Are you finding it hard to activate your pelvic floor?
Do you have incontinence when you cough, laugh, sneeze or lift for example
Do you have urinary frequency or urgency?
Do you have bowel incontinence or urgency?
Did you have bowel surgery?
Do you have pain emptying your bowel?
Do you feel you empty your bowel completely?
Have you ever been diagnosed with pelvic organ prolapse (POP)?
Do you experience a sensation of pressure or pain in the vagina or rectal area?
Do you have any discomfort when inserting or wearing tampons?
Do you have any hormonal imbalance problems?
Do you have a thyroid disease (over or under?)
Do you suffer with chronic Candida (thrush)?
Have you been on a course of antibiotics?
Do you have a history of endometriosis?
Do you have pain during intercourse?
Any history of low back pain?
Did you have a C section?
Has it healed well?
Do you have pain at the scar?
Have you have perineal stitches?
Do you have any pain sitting?
Do you have any pelvic floor dysfunction (hypertonic, hypotonic, pudendal nerve?)
Did you exercise during pregnancy?
Are you currently exercising?
Do you have any other conditions that you think is relevant?
If the answer to any of the above is yes please give more information below
Submit
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