Perinatal Exercise and Wellbeing courses

Perinatal Exercise and Wellbeing courses
Thank you for your interest in our new postnatal and antenatal courses.

The courses are aimed at those who are currently inactive or less active than usual and would like to change this and improve their mental health.

Our antenatal course is for anyone who is pregnant.

Our postnatal course is for anyone who has given birth in the last year. We ask that participants have had their 6-week post-birth check before joining.

Both courses will offer:

* Support to be more physically active and improve mental health.

* A wellbeing workshop and gentle yoga-based exercise session each week.

* Discussion and tools around managing mental health and wellbeing during pregnancy and beyond.

* An introduction to content from the Best Beginnings Baby Buddy app.

We are in the process of finalising the details of the upcoming courses, which we hope will take place later this year.
If you would like to join, please complete the questions below.
Name*

First NameLast Name
Email*
example@example.com
Are you happy for us to contact you at this email address?*

YesNo
Phone Number*
Are you happy for us to leave a voicemail message at this number?*

YesNoVoicemail not available
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Your date of birth*

DayMonthYear
Which course would you like to attend:*

Antenatal (before birth)Postnatal (after birth)
Expected date of delivery (for antenatal)

DayMonthYear
Date of birth of baby / babies (for postnatal)

DayMonthYear
Ages of any other children
Do you consider yourself to have a disability?*

NoYesPrefer not to answerMental healthPhysical conditionSensory conditionLearning needOther
If yes, please let us know any adjustments we could make to help support you
If the course is run online, do you have the necessary equipment (computer, internet, web cam) and a safe and confidential space to talk freely, and exercise in?*
Is there anything else you would like us to know?
Please complete the following questions regarding your activity levels and the Physical Activity Readiness Questionnaire below.
In the past 7 days, a continuous walk lasting at least 10 minutes?*

YesNo

If yes:

	Please type your answer
On how many days did you do a walk lasting at least 10 minutes?
How many minutes did you usually spend walking on each day that you did the activity?
Was the effort you put into walking usually enough to raise your breathing rate?

In the past 7 days, have you done a cycle ride?*

YesNo

If yes:

	Please type your answer
On how many days did you do a cycle ride?
How many minutes did you usually spend cycling on each day that you did the activity?
Was the effort you put into cycling usually enough to raise your breathing rate?

In the past 7 days, have you done sport, a fitness activity (such as gym or fitness classes), or dance?*

YesNo

If yes:

	Please type your answer
On how many days did you do sport or a fitness activity lasting at least 10 minutes?
How many minutes did you usually spend exercising on each day that you did the activity?
Was the effort you put into the sport or fitness activity usually enough to raise your breathing rate?

PhysicalActivity Readiness Questionnaire (PAR-Q)

For most of us, taking part in physical activity will benefit our physical and mental health. The PAR-Q is designed to identify the small number of adults (age 15-69) for whom physical activity might be inappropriate, or those who should have medical advice concerning the type of activity that would be most suitable for them. *

	Yes	No
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem that could be made worse by a change in your physical activity ?
Is your doctor currently prescribing drugs (for example, water pills)for your blood pressure or heart condition?
Do you know of any other reason why you should not do physical activity?

If you answered YES to one or more question: If you have not recently done so, we advise that you consult your doctor by telephone or in person before increasing your physical activity. Tell the doctor which questions you answered ‘yes’ to, or present your PAR-Q copy. Seek advice from your doctor as to your suitability for:

1. Unrestricted physical activity starting off easily and progressing gradually

2. Restricted or supervised activity to meet your specific needs, at least on an initial basis
Assumption of risk

I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in exercise, that I understand what the activity involves and that my participation involves a risk of injury. I agree to inform my exercise tutor of any changes in my health which may affect my participation.
Signature*

Clear
Print name*

First NameLast Name
Date*

DayMonthYear
Thank you for completing this referral form.
* Before the start of the course, we like to have a short chat with all the participants. Someone from Oxfordshire Mind will be in touch to arrange this, usually within 5 working days. We look forward to speaking with you soon!
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Perinatal Exercise and Wellbeing courses

If you would like to join, please complete the questions below.

Please complete the following questions regarding your activity levels and the Physical Activity Readiness Questionnaire below.

PhysicalActivity Readiness Questionnaire (PAR-Q)

Thank you for completing this referral form.

* Before the start of the course, we like to have a short chat with all the participants. Someone from Oxfordshire Mind will be in touch to arrange this, usually within 5 working days. We look forward to speaking with you soon!