• Pelvic Floor Reconnect

    Client Health Pre-Screen Questionnaire
  • Your Questionnaire

    Thank you for taking the time to fill out your client health questionnaire. We understand this is an extra thing to do but please take the time to answer all questions as honestly and fully as you can. Each question has been designed to carry out our duty of care. If you decide not to answer a question then that is fine but it may mean we cannot provide you with the best service and in some cases we may not be able to work with you until we have further information. Please note that we only use this information to ascertain whether we can help you, what we can help you with and to provide you with the best service possible. We will not share this information with anyone else.
  • Your Contact Details

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    Pick a Date
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    Pick a Date
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  • Your Medical Team

    Use this section if you would like us to work alongside your medical professional or if we will need to consult with your medical team to make sure the exercises are right for your case. This is particularly relevant if you are recovering from prolapse surgery or similar.
  • Your Pregnancy History

  • Your General Health

    This section is to ascertain your general readiness to pursue physical activity.

  • Postnatal Pre-activity Pre-Screen

    Do you currently or have you ever suffered any of the following conditions? Please tick if YES and use the box below to give further details.

  • Thank you for taking the time to fill in your health questionnaire.

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    You selected that you are currently pregnant.  Congratulations! We hope you are feeling well.

    However, this program is not suitable during pregnancy.  You will be offered a full refund.

    Please do keep us in mind for your postnatal period and any pregnancy related courses that may be available in the future.

    We thank you for your interest, it means a lot to us!

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