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Postnatal doula
Retreats
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About me
Sign In
My Account
Cart
0
Yoga
Book
Postnatal doula
Retreats
Online circles
About me
Postnatal health information form
Name
*
First Name
Last Name
Email
*
Contact phone number
*
(only used in the event of unexpected class cancellation)
Baby's name
*
Baby's date of birth
*
Please list briefly any medical issues you had during pregnancy:
Since the birth have you experienced any of the following (please tick):
Sacro-iliac pain
Prolonged bleeding (lochia)
Anaemia
Sciatica
Exhaustion
High blood pressure
Mastitis
Piles (haemorrhoids)
Anxiety
Depression
Pelvic girdle pain
Stiff neck/shoulders
Back pain
Diastasis recti
Please describe anything else about your birth that is relevant for how you feel physically/emotionally at the moment:
Please give details of any other health condition or injury:
Please give details of any medication you or your baby are on, or if your baby has any medical condition I should be aware of?
How did you hear about Stretched Mums Yoga?
Please tick if you are happy to be added to my mailing list:
*
Yes
No
Thank you!