The Postnatal Course 2.0 - Application Form
Please take your time with this and include as much detail as you're happy to share - because I want this course to feel 'personalised' it helps me to get to know you a bit before we get started - plus it means I can tweak the content of the coaching calls so they are designed with ALL members' in mind.

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Email *
Full name: *
Like to be known as: *
Your Date of Birth: *
Mobile number - IF you want to be added to the Group What's App for the Course (this is quite handy for any last minute changes to the class schedule): *
Where are you based? *
Baby's name: *
Baby's Date of Birth: *
Baby's Birth Weight: *
What type of delivery did you have? *
If you had a vaginal birth, did you suffer any tearing or undergo an episiotomy?
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If you suffered a tear, was it given a grade?
Please provide any additional details of your pregnancy and/or postnatal recovery so far (any complications, illnesses, visits to GP or other healthcare practitioners such as chiropractor, acupuncturist, physio, osteopath) *
Please let me know any details of previous deliveries that may be useful to know (i.e how the pregnancies were, type of delivery, how your recovery was)
Other than your new baby, do you have other children at home?
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If you do have other children at home, please list their names and ages below:
Are you: *
Do you have any of the following to support you with childcare?
Are you breastfeeding? *
On a scale of 1 to 10 how would you rate your sleep? (1 being awful and 10 being great!)
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Please provide details if you can (i.e. is baby sleeping through the night, do you manage to nap during the day) *
Do you currently have, or have you ever suffered from any of the following: (tick as many as apply) *
Please provide details of any symptoms ticked above (were these in the past, how long did they last, did you seek treatment or are they current and are you receiving treatment?)
Are you concerned about diastasis? *
Has your abdominal wall been assessed for diastasis by a physio, or have you self-assessed? *
If yes, how wide is the gap at rest?
Are you currently experiencing difficulty with your bowel, wind or urinary urges (i.e. can you hold it until you are able to go)? *
Do you ever lose urinary control when laughing, sneezing, coughing, jumping or moving quickly? *
Do you currently or have you ever needed to wear incontinence pads? *
Are you incontinent overnight? *
Are your bowel movements or urination painful? *
Do you ever experience a sensation of pressure in your vagina or rectum (like a tampon falling out) or noticed any protrusions from either? Or has anyone ever said you may have a prolapse? *
If you have been assessed for, or diagnosed with a prolapse, please give details - i.e what type of prolapse and a grade if you were given one:
Are you still experiencing lochia (postnatal bleeding)? *
Have you had a recently fitted IUD? *
Have you attended a 6/8 week check up with your GP? *
If you have, has your GP specifically 'cleared' you for exercise? *
Are you on any regular prescribed medication? *
If yes, please give details:
On a scale of 1 to 10, how would you rate your fitness BEFORE your most recent pregnancy? *
Please provide details of any regular exercise you did before getting pregnant: *
On a scale of 1 to 10, how would you rate your fitness DURING your most recent pregnancy? *
Please provide details of any regular exercise you did during your pregnancy: *
On a scale of 1 to 10, how would you rate your fitness since giving birth? *
Please provide details of any regular exercise you've been doing since giving birth: *
Have you been given any specific exercises to do by a healthcare provider (e.g. physio)? *
If yes, please provide details:
Have you ever been advised by your doctor that you have a heart condition and should ONLY do physical activity recommended by a doctor? *
Do you ever feel pain in your chest when you do physical activities? *
Have you ever felt chest pain when NOT doing physical activity? *
Do you ever lose consciousness or fall over as a result of dizziness? *
Do you have a bone or joint issue that is aggravated by physical activity? *
If yes, please provide details:
Has your doctor ever recommended medication for your blood pressure or heart condition? *
Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision? *
If yes, please provide details:
How is your health in general, do you need to tell me about any other health issues that you have? *
How are you feeling emotionally? Tick all or any that apply: *
If other, please share below:
What are you your biggest CONCERNS going into The Postnatal Course? *
List below any questions you might have in your head already about returning to exercise... *
I have read, understood and completed this questionnaire to the best of my knowledge: *
I UNDERSTAND that it is up to me to determine whether I am ready to return to exercise, to seek GP sign off or advice from a physio as to whether I am ready if I am not sure, and to adapt my movements or stop altogether on any given day if the movements do not feel suitable for my body. I UNDERSTAND that this Course is designed as an educational resource and that I am signing up to this Course at my own risk. *
Please type your name and today's date below (to serve as an electronic signature): *
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