Prenatal Health Questionnaire Name* First Last Email* Phone*Please answer as many questions as applicable. Anything you are unsure about, don't worry, message me on 07727 015703 xDue Date* DD slash MM slash YYYY Hospital you are assigned to / Homebirth*Emergency Contact Details ( Name & mobile number)*Please share any relevant / important information relating to previous pregnancies, such as illness or negative outcomes. Be assured this will be treated with utmost confidentialityPrenatal conditionsPlease tick if yes Symphysis Pubis Dysfunction Sacrum or SI joint pain Carpal Tunnel Syndrome Gestational Diabetes Low back pain Varicose Veins Bleeding during or after exercise Pain in upper and mid back If Yes to anything above, add details or share any other symptoms:Have you done yoga before? If so, how much?*Complete beginners welcome!Is there anything else I need to know before you exercise?Sign here*Please note if your health changes or you feel unwell in class, do please let me know. You take full responsibility for your own health and safety during class. If you have any reason to believe you may be at risk, check with your doctor or midwife before taking part in class. By typing your name and date below, you agree with these terms and conditions, thank youSign me up to the mailing list!I email seasonal tips, special offers, classes and workshops info each month. In the run up to workshops, more frequently to advise of places. You are free to unsubscribe at any time. Yes please, I want to hear more Δ