Post-Natal Medical Forms | Sussex Reformer Pila

First name

Last name

Email

Phone

Delivery Date

Did you have any of the following?

Forceps used

Episiotomy

Tearing

Caesarean Section

If so, what grade?

Are you breast-feeding?

Yes

No

Do you still suffer from any of the following?

If you have selected any of the above, please provide details.

What exercise were you doing, if any, during pregnancy?

What exercise, if any, have you been doing since giving birth?

Does your doctor/midwife know you are returning to exercise?

Are there any other medical issues we should know about?

Have you had an abdominal check (rec check)?

I can confirm the information I have given here is correct and I will inform my instructor if I have any changes in my current circumstances.

Signature

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Post Natal PAR-Q