YOUR ACCOUNT Pregnancy Form First Name* Surname* Date Of Birth* DD slash MM slash YYYY Email* Have you practised yoga before?* Yes No If yes for how long?How did you hear about this course?*Select:A friendFacebookWebsiteAbout Your PregnancyIs this your first pregnancy?* Yes No How 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?* Yes No High Blood Pressure?* Yes No High / Low Blood Pressure?* Yes No Low Blood Pressure?* Yes No Dizziness or Fainting?* Yes No Diabetes?* Yes No Pre-eclampsia* Yes No Oedema (swollen limbs)?* Yes No Pubic / Pelvic Pain?* Yes No Have you undergone IVF Treatment?* Yes No Further Information About YouAny allergies?* Yes No Do you take any regular medication?* Yes No Have you had any significant medical conditions, injuries or operations (past or present)?* Yes No Have you ever had a miscarriage?* Yes No CAPTCHA
