Questionnaire

Tots, Squats and coffee potsPlease complete and submit the questionnaire below before your first Tots, Squats and Coffee Pot’s session:


Tots, Squats and Coffee Pots’ health Questionnaire
  •   Diabetes
      Chest Pain
      High BP
      High Cholesterol
      Irregular Heartbeat
      Heart Disease
      Blood Disorder
      Arthritis
      Dizziness
      Shortness of Breath
      Asthma
      Vaginal Bleeding
      Varicose Veins
      Miscarriage
      Incontinence
      Back/Neck pain
      Knee/Hip pain
      Pelvic/Abdominal cramps
      Hypoglycaemia
      Symphysis
      Pubis Dysfunction
      Carpal Tunnel Syndrome
      Depression
      C-Section Wound Discomfort
      Gestational Diabetes
  •   Yes
      No
  •   Yes
      No
  •   Yes
      No
  •   Yes
      No
  • I can confirm that I am able to participate in suitable postnatal exercise and that I have had my GP 6/8 week check-up and been given the all clear. I fully understand that there are risks associated with exercise and my participation in the class and the safety of my child/children are my responsibility and that I would inform the instructor if I was to feel unwell at any point during the class.

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