Post Natal Client Questionnaire

At Fit For Life, we prioritize the well-being of our post-natal clients. To ensure a safe and effective fitness journey, we kindly ask you to fill out the following questionnaire.

Name *

Date of birth *

Email Address *

Phone number

Are you currently taking any medication? *

Yes
No

Have you ever suffered from heart problems? *

Yes
No

Do you suffer from high or low blood pressure? *

Yes
No

Do you suffer from asthma or respiratory problems? *

Yes
No

Do you suffer from diabetes or epilepsy? *

Yes
No

Do you have a medical condition not mentioned in the above that may need special attention your exercise program? *

Yes
No

If ‘Yes’ to the above, please expand. Give as much detail as possible.

How many weeks post pregnancy are you: *

1-6 weeks
7-12 weeks
12-24 weeks
24+ weeks

Type of birth? *

Did you experience any complications with your delivery (e.g. episiotomy, haemorrhage etc)? *

Have you ever experienced incontinence post pregnancy? *

Yes
No

Do you have diastasis recti (separation of the abdominal muscles)? *

Yes
No

Have you or do you experience any post natal depression? *

Yes
No

Do you have any other pregnancy related issues that need special attention during your post natal package? *

Yes
No

If ‘’Yes’ to the above, please expand. Provide as much detail as possible.

Are you currently breast feeding? *

Yes
No

Exercise activity level PRIOR to pregnancy: *

Sedentary
Light (1-2 sessions p/w)
Active (3-4 sessions p/w)
Very Active (5-7 sessions p/w)
Athlete (8+ sessions p/w)

What type of exercise did you do regularly PRIOR to pregnancy (e.g. free weights, running, circuit classes etc)? *

Exercise activity level DURING pregnancy: *

Sedentary
Light (1-2 sessions p/w)
Active (3-4 sessions p/w)
Very Active (5-7 sessions p/w)
Athlete (8+ sessions p/w)

Where would you like to complete your exercise sessions: *

Home
Gym
Both of the above

Leave this field empty