Your Name Your Email How long has it been since you gave birth? a) 6-12 weeks b) 3-6 months c) 6-12 months d) more than a year Was your delivery a) vaginal birth b) cesarean c) labour leading to emergency cesarean Do you have any health conditions that limit your ability to exercise? If yes, please explain. Were there any complications during your pregnancy or any prior pregnancies? If yes, please explain Since giving birth, have you experienced any of the following health problems: a) Urinary incontinence b) Discharge c) Sciatica d) Pelvic organ prolapse e) Low back pain f) Postpartum eclampsia g) Postpartum anemia h) Severe abdominal separation i) Prolonged pelvic girdle pain j) Symphysis Pubis Dysfunction k) Spinal headaches l) None of the above For vaginal birth clients, have you experienced any of the following: a) Perineal tears b) Lingering pain in the perineum c) Stitches due to tearing/stretching d) Leakage during exercise or exertion e) Leakage during coughing, sneezing, laughing etc f) None of the above For cesarean birth clients, have you experienced any of the following: a) pain or burning at incision site beyond 6 weeks b) swelling, discharge or infection at incision c) pain in incision during coughing, sneezing, laughing etc d) painful bowel movements e) lingering pain/reaction to spinal block f) None of the above Are you currently breastfeeding? Yes No Did you exercise during pregnancy/or have done any recent exercise program? If yes, please describe What are your exercise goals at the moment and what do you hope to achieve from this program? Is there anything else you would like us to know about yourself or your childbirth or fitness journey? Enroll Now
