Pregnancy Health Screening Form


Please complete and return this questionnaire at least 24 hours before you first session.


All information is kept confidentially and is used to ensure that you are safe and ready to participate in class. Please answer questions honestly and with as much detail as you can.


Many Thank


Personal Details
Medical Screening



If you answered yes to one or more questions, you must check with your doctor before taking part.

Pelvic Health
Further Information Relating to Participation in Antenatal Exercise



Please check the boxes below to confirm that you understand the following:

I hereby confirm that the information stated above is answered to the best of my ability. I further fully understand that thorough and honest responses to these questions are essential to my safety. I undertake to inform my instructor (Natasha Sahota) should any answers to the above information change.