Pre-Natal Booking Form (PARQ)

Pre-Natal Booking form (PARQ) and Health Checklist
Please complete and submit this booking form, physical activity readiness questionnaire (PARQ) and health checklist before taking part in any activities.

* Indicates required field

Email *

Name *

First

Last

Phone Number *

Package you would like. Full Pre-Natal online package or the individual online class you would like to attend: Monday 6pm Pilates or Thursday 6pm Yoga *

Where did you hear about Absolute Yoga and Pilates? *

What are your motives for exercising? *

Agreement:

We will make every effort to accommodate your course booking, however dates and times are subject to availability.
By submitting this booking form, you agree to the dates selected and understand that payment cannot be refunded if you are unable to attend.
Full payment for services is required in advance (for early bookings, a deposit payment will secure a space).
You need to complete the Physical Activity Readiness Questionnaire (PARQ) below and Pre-Natal health checklist.
By submitting this booking form, you have asked to receive emails and communications from us. This will keep you informed on current services available. You can unsubscribe at any time. This is following General Data Protection Regulations (GDPR) 25th May 2018.

Health Screening: All information will be treated confidentially
Please answer every question. Some questions will only require a yes or no.

How many weeks pregnant are you? If post-natal, please write post-natal and the number of weeks? *

If you are pregnant, what date is your baby due? If post-natal, when did you have your baby? *

Has your doctor ever said that you have a heart or lung condition and that you should only do physical activity recommended by a doctor? *

Do you ever feel pain in your chest when you do physical activity? *

In the last month, have you had chest pain when you are not doing physical activity? *

Do you have diabetes that developed before or during your pregnancy? *

Do you lose your balance because of dizziness or do you ever lose consciousness? *

Do you have a bone or joint problem, for example, back, knee or hip? Do you suffer from physical impairments or diseases of the bones or muscles? If you answer yes you are advised to seek advice from a health care professional first. See declaration below *

Is your doctor currently prescribing drugs for high blood pressure or a heart condition? If you answer yes you are advised to seek advice from a health care professional first. See declaration below *

Do you have a history of premature labour? *

Is your placenta implanted completely over or near your cervix (placenta previa)? *

Have you had 3 or more miscarriages? *

Have you experienced cramping, spotting or bleeding during your pregnancy? *

Are you carrying more than one baby? *

Is there any other reason why you should not participate in physical activity? *

IF YOU HAVE ANSWERED YES TO ONE OR MORE QUESTIONS
You must talk to your doctor, midwife or health care professional by phone or in person before you start a new exercise class. Tell your health care professional about the questionnaire and which questions you answered YES to. If you have already got medical clearance for Yoga/Pilates or moderate exercise in general, please fill in the declaration below.

You may be able to do any activity you want – as long as you build up slowly and gradually. Or you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activity you wish to participate in and follow his/her advice. Yoga/Pilates exercises are generally safe for most people, it improves flexibility and strengthens your deep postural muscles – particularly your deep abdominals and back muscles – as well as improving your overall posture and body awareness and pelvic floor.

IF THE ANSWER IS NO TO ALL PARQ QUESTIONS you can reasonably be sure that you can start to become more physically active and take part in a suitable exercise programme.

PLEASE NOTE

If your health changes subsequently so that you answer YES to any of the above questions and you have started a class with us, please inform your teacher. You will also need to stop your classes until you are clear to continue on the advice of your health care professional.
If you are temporarily unwell (e.g. cold or flu), delay becoming more active until you are better.
If your doctor has recommended that you avoid any movements, make sure that you let your teacher know.

By submitting this booking form you confirm you have read and understand this questionnaire. If you have any concerns, contact us by email and ensure you speak with your instructor at the start of your class.

DECLARATION This applies if you have answered yes to any of the above questions. I declare I have been cleared by my doctor (GP, specialist or other qualified health professional) to take part in moderate exercise. Please input your full name to indicate your informed consent. *

Submit

Prices:
Access to online Pre-Natal live-streamed classes and recorded Pre-Natal classes in our video library £15 per week, booked in 4/5 week blocks. Please check the price to join today, this is calculated on the number of remaining weeks.

Book one online Pre-Natal class for £10. We are confident you will love it and want to register for more.

Absolute Yoga and Pilates;
'Friendly classes that help you enjoy a healthy and balanced life'

t: Pauline 07821 969405
e: pauline@absoluteyogaandpilates.co.uk

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Pre-Natal Booking form (PARQ) and Health ChecklistPlease complete and submit this booking form, physical activity readiness questionnaire (PARQ) and health checklist before taking part in any activities.

Pre-Natal Booking form (PARQ) and Health Checklist
Please complete and submit this booking form, physical activity readiness questionnaire (PARQ) and health checklist before taking part in any activities.