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  • Antenatal Pilates- Health Questionnaire

    Please Read and complete the following questions as fully as you can. The information you share will allow me to tailor your class experience to your specific needs. All details given on this form will be kept in the strictest confidence. Please keep me updated and advise me immediately if any of the given information changes. Thank you.
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  • Medical Information




  • Previous pregnacy/birth

    please skip if doesn't apply


  • Please note:

  • Should any of the below or other symptoms develop during your pregnancy, please inform me immediately.

    o   If you are unwell both emotionally or physical

    o   If you are very tired, light headed or feeling faint

    o   If you have a high temperature

    o   If you have abdominal pain

    o   If you have pelvic girdle pain

    o   If you feel short of breath

    o   If you experience bleeding

    o   If you had two or more miscarriages

    o   If you experience high blood pressure

    o   If you have developed diabetes

    o   If you suffer from epilepsy.

    o   If exercise causes a burning, achy sensation

    o   If you feel dehydrated or have a headache

    o   If you experience blurred vision

    o   If you are experiencing contractions

    o   If you are experiencing fist stage labour

    o   If you have compromise cervix

    o   If you have calf pain or swelling

     

     

  • Declaration:
    I have answered the questions above to the best of my belief and know of no other reason why I should not undertake a course of exercise. I have disclosed all relevant information and will inform my teacher if my medical condition changes in the future.

    I understand that all exercise carries a risk of injury. I accept responsibility for my own body and baby and will stop exercising if I need to I will inform the teacher of any symptoms, physical discomfort or injuries that may arise.

    I also understand that my teacher may offer me professional advice relating to adapting particular exercises or to my ability to exercise, and that she may consider it unprofessional to continue to teach me, if I do not wish to follow such advice.

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