Baby And Me (Postnatal) Yoga Form Get customers medical information for yoga classes First Name*Surname*Date Of Birth* Date Format: DD slash MM slash YYYY Email* Have you practised yoga before?*YesNoIf yes for how long?How did you hear about this course?*Select:A friendFacebookWebsiteBaby's Name*Baby's Date of Birth* Date Format: MM slash DD slash YYYY Did you baby arrive:*Full-TermPrematureOverdueDelivery Type:*Select:VaginalMedical InterventionC-sectionPrevious Births?*YesNoIf yes, please give ages of older children*Pelvic Instability?*YesNoPubic pain?*YesNoBack or neck pain?*YesNoHigh / Low Blood Pressure?*YesNoProlonged bleeding?*YesNoAnaemia?*YesNoConstipation?*YesNoVaricose Veins?*YesNoFluid Retention?*YesNoSciatica?*YesNoExhaustion?*YesNoAny other health issues not mentioned above, please specify below:Does your baby have any medical conditions? Please specify below*Any allergies?*YesNoDo you take any regular medication?*YesNoHave you had any significant medical conditions, injuries or operations (including c-sections)?*YesNoCAPTCHA
