Fit Strong Mum Pre Natal Screening Questionnaire

DD slash MM slash YYYY
Home address(Required)
How often do you currently exercise?(Required)
What type of exercise do you CURRENTLY enjoy doing? (tick all that apply)(Required)
On a scale of 1-10 where do you feel your current cardiovascular fitness lies?(Required)
On a scale of 1-10 how stressful is your job on a daily basis?
Do you smoke?(Required)
How many units of alcohol do you drink per week?(Required)
Looking at yourself both mentally and physically, how happy do you feel?(Required)
Are you pregnant now?(Required)
Is this your first pregnancy?(Required)
In this or any other pregnancy, have you suffered from any of the following?(Required)
Do you have any other children(Required)
Did you have a tear/episitomy?
Do you feel that you have healed mentally and physically from birth?
Are you currently breastfeeding?
POST BIRTH ONLY - Have your been cleared for exercise by a GP?
Was your diastasis recti (abdominal separation) checked and cleared by a professional post birth?
Are you under the care of a consultant?
Exercise in pregnancy is recommended by the department of health in the UK. It is suggested that a pregnant woman try to remain active for a minimum of 30 minutes per day, or 150 minutes per week. 75 minutes of that time should be dedicated to resistance style training for both maternal health and postnatal recovery. When undertaking an exercise programme with myself or another employee of Fit Strong Mum (Rossell Fitness), it is essential that you are honest and open with us at all times regarding your health, and the health of your unborn child, so that we can keep you safe. Every session that we undertake can be adapted and it is important that we listen carefully to your body and work with how you feel on that day. Even an accompanied walk and a chat can help combat fatigue/morning sickness and general hormone imbalances that come along with pregnancy. It is your responsibility to inform me of any changes to yours or your baby's health that you feel may impact our sessions, as well as any abnormalities such as excess bleeding, feelings of dizziness etc. If you are happy with all of the above, please fill in today's date which will be taken as a legally binding signature.