Your Name Your Email How far along in your pregnancy are you? a) First Trimester b) Second Trimester c) Third Trimester Do you have any health conditions that limit your ability to exercise? If yes, please explain. Have you had any prior pregnancies that developed complications or resulted in a loss of pregnancy? If yes, please explain Has your doctor diagnosed any complications with this pregnancy or preconception? If yes, please explain During this pregnancy, have you experienced any of the following: a) Vaginal bleeding or spotting b) Faintness or dizziness c) Fetus not growing to gestational age d) Lack of weight gain e) Excessive swelling f) Extreme fatigue g) Extreme nausea or vomiting h) Pelvic girdle pain i) Symphysis Pubis Dysfunction j) None of the above Were you previously exercising before or during this pregnancy? What are your fitness goals during pregnancy and what do you hope to achieve from this program? Is there anything else you’d like us to know about yourself or your pregnancy? Enroll Now
