Adapt Movement Online Program Screening
Let’s guide you into the right program safely. This screening helps us understand your current stage, symptoms, and goals so we can place you in the most appropriate online program.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Which of the following best describes you right now?
*
Currently pregnant
Recently given birth
Neither of the above
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Prenatal Screening
What trimester are you in?
First (0–13 weeks)
Second (14–27 weeks)
Third (28–40+ weeks)
Have you been given any advice from your healthcare professional to refrain from physical activity?
Yes
No
Have you ever experienced a miscarriage?
Yes
No
Are you experiencing any pregnancy complications?(Select all that apply)
Have you experienced recent bleeding, cramping, or dizziness?
Yes
No
Are you experiencing any musculoskeletal symptoms?
What was your pre-pregnancy exercise routine on average?
Low intensity activity 2-5 days weekly
Moderate intensity activity 2-5 days weekly
High intensity activity 1-4x weekly
No structured exercise weekly.
Have you been diagnosed with any of the following during this pregnancy? (Select all that apply)
Have you experienced any of the following warning signs during exercise?
During your current trimester, have you noticed:First trimester
Second trimester
Third trimester
Does your regular occupation involve:
What are your top priorities during pregnancy?(Choose up to 2)
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Postpartum Screening
Have you given birth recently?
Yes
No
How many weeks postpartum are you?
0-2
2-6
4-12
12-26
27+
What type of delivery did you have?
Vaginal (no complications)
Vaginal with complications (tears, vacuum, etc.)
Caesarean
Caesarean with complications
Have you had your 6-week postnatal check-up?
Yes – cleared
No – not yet
Yes – not cleared
Are you experiencing any of the following symptoms?(Select all that apply)
Are you currently breastfeeding?
Yes
No
What’s your current activity level?
Mostly resting
Light walking or stretching
Back to some exercise
Resuming regular workouts
What are your current goals?(Choose up to 2)
Pelvic Floor and Core Screening
Have you been assessed by a women’s health physiotherapist?
Have you been diagnosed with pelvic organ prolapse?
Do you experience leaking during jumping, coughing, or lifting?
Do you notice abdominal bulging or doming during effort?
If Caesarean selected earlier:
Is your scar fully healed?
Do you experience pulling, numbness, or pain around the scar?
Has a medical professional cleared you for abdominal strengthening?
Have you experienced:
Persistent low mood
Anxiety affecting daily function
Feeling overwhelmed beyond normal adjustment
Postnatal depression diagnosis
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Not quite the right fit, but we've still got you!
This screening is designed specifically for our pregnancy and postpartum programs, so it looks like it's not the right starting point for you right now. The good news is AMC has plenty of other programs that might suit what you're after. Just visit our website adaptmovementcollective.com.au for more details.
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