Welcome to Fit For Life's Pre Natal Client Questionnaire

At Fit For Life, we are dedicated to supporting expecting mothers on their fitness journey. To ensure the safety and effectiveness of our Pre Natal Packages, we kindly ask you to fill out this Physical Activity Readiness Questionnaire.

Name *

Date of birth *

Email Address *

Phone number

How many weeks pregnant are you? *

1st Trimester (1-12 weeks)
2nd Trimester (13-27 weeks)
3rd Trimester (28-40 weeks)

Are you currently taking any medication? *

Yes
No

Have you or do you experience any of the following symptoms: *

Bleeding from vagina (‘spotting’)
Faintness or dizziness
Abdominal pain
Sudden swelling of the ankles, hands or face
Persistent headaches
Swelling, pain or redness in the calf of one leg
Shortness of breath
Absence of fetal movement (after 6 months)
None

If yes to any of the above, please expand. Give as much detail as possible.

Have you ever suffered from heart problems? *

Yes
No

Do you often feel faint or have spells of dizziness? *

Yes
No

Do you suffer from high or low blood pressure? *

Yes
No

Do you suffer from asthma or respiratory problems? *

Yea
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 in an exercise program? *

Yes
No

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

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 since being pregnant: *

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 kind of physical activity do you feel comfortable doing during pregnancy? *

Where would you like to complete your exercise sessions: *

Home
Gym
Both of the above

Leave this field empty