Postpartum/Postnatal Yoga Intake Form

Congratulations on the birth of your baby(ies)! This course will help you use the breathing techniques and movement practices to progressively recover from childbirth. Thank you for taking the time to fill out this form so I can better understand how to support you on your journey into parenthoood.

Full Name*

First NameLast Name

I would like to register for (check all that apply)

14 Jan. - 18 Feb. 2025 ~ Postnatal Yoga: Core & Floor Restore (1 𝙨𝙥𝙤𝙩 𝙡𝙚𝙛𝙩), Tuesdays @ 14:00, 6 sessions, chf 24011 March - 15 April 2025 ~ Postnatal Yoga: Core & Floor Restore (6 𝙨𝙥𝙤𝙩𝙨 𝙡𝙚𝙛𝙩), Tuesdays @ 14:00, 6 sessions, chf 240Private Postpartum/Postnatal sessions

Mobile Phone Number*

E-mail*

Baby's(ies) Name(s)

Baby's(ies) age(s)

What is your level of yoga?

New to yogaBeginnerIntermediateAdvanced

What do you want to achieve from these sessions (check all that apply)

Did you have a vaginal or cesarean delivery?

Are you currently breastfeeding?

Prior to this birth, have you had any injuries, chronic pain, or had surgery that could affect your yoga practice within the last two years?

I have the following conditions (check all that apply)

Postpartum bleeding or lochiaDiastasis recti (a partial or complete separation of the abdominal muscles)Hypertonic Pelvic Floor (tight pelvic floor muscles that are unable to relax)Hypotonic Pelvic Floor (weak pelvic floor muscles)I do not know- I have not had an appointment with a physical therapist yet.Other

Describe any movements/types of exercises you should avoid, include recommendations from your doctor/midwife/physical therapist/osteopath.

Does your baby have any medical conditions or injuries?

Do you have anything you would like to ask or share relating to your pregnancy, childbirth, or motherhood?

In general, how are you feeling now?

How did you hear about this course?

Postpartum Recovery/Postnatal Yoga