YOUR ACCOUNT Pregnancy Form 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 friendFacebookWebsiteAbout Your PregnancyIs this your first pregnancy?*YesNoHow many weeks pregnant are you and what is your due date?*Planned place of birth?*Have you ever experienced any of the following?Backache or pain?*YesNoHigh Blood Pressure?*YesNoHigh / Low Blood Pressure?*YesNoLow Blood Pressure?*YesNoDizziness or Fainting?*YesNoDiabetes?*YesNoPre-eclampsia*YesNoOedema (swollen limbs)?*YesNoPubic / Pelvic Pain?*YesNoHave you undergone IVF Treatment?*YesNoFurther Information About YouAny allergies?*YesNoDo you take any regular medication?*YesNoHave you had any significant medical conditions, injuries or operations (past or present)?*YesNoHave you ever had a miscarriage?*YesNoCAPTCHA
