Post-natal PAR-Q – Bumps and Bubs

Prior to starting with Bumps & Bubs, we require everyone to complete a Physical Activity Readiness Questionnaire (PAR-Q). All data is securely stored in accordance with GDPR guidelines.

Post-natal PAR-Q

Your details

First Name

Last Name

Address

Address Line 1

Address Line 2

City

Post Code

Country

Date of Birth

Emergency contact

Name

Contact Number

Your health

Have you had your six-week checkup with your GP?

Did your GP recommend any limitations to exercise, and what are they?

Unfortunately we are unable to begin training with anyone who has not been cleared for exercise by their GP, please contact us to discuss your options.

Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?

Yes

Do you feel pain in your chest when you perform physical activity?

Yes

In the past month, have you had chest pain when you were not performing any physical activity?

Yes

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

Yes

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Yes

Is your doctor currently prescribing any medication for your blood pressure or for a heart condition?

Yes

Do you know of any other reason why you should not engage in physical activity?

Yes

If you have answered Yes to any of the above, have any other medical condition or are taking any medication please write this below

Have you ever had surgery or experienced any other major medical event you want me to know about, or that may impact your training?

Your child and your birth experience

Child’s name

Date of child’s birth

Birth Type

Did you experience any tearing?

Degree of tearing

Did you have any birth complications?

Please provide details of any complications

Are you currently experiencing any postpartum bleeding?

Have you consulted a doctor about it?

Your Pregnancy and Postnatal Experience

How did you feel throughout this pregnancy?

Did you experience any symptoms or issues that impacted your ability to train?

How have you felt generally since giving birth?

What’s your current activity level?

Please include daily movement, going for walks etc

Is there anything else you’d like me to know about this pregnancy or birth?

A little more about you

The following questions are optional, but will help us tailor our training to your needs.

During classes and sessions we discuss different topics such as pelvic floor health, nutrition, sleep, and stress. As these factors may all have an impact on your training and your results to varying degrees.

Pregnancy and birth is amazing but can also be difficult time for mothers and woman may have experienced trauma. Is there anything that you are uncomfortable discussing during sessions?

We are a breastfeeding friendly venue and private space to feed is available. We also have bottle wamers and facilities for heating food for babies and toddlers.

Are you currently breastfeeding?

This question is asked as certain exercise positions may be uncomfortable for breast feeding mothers.

Pelvic Health

This is being asked is some exercises may have to be adapted for your needs.

Have you experienced any of the following:

Heaviness, dragging, or bulging in the pelvic area

Pelvic pain

Pain around C-section incision/scar

Diagnosis of pelvic organ prolapse

Leaking urine while coughing, sneezing, exercising, or exerting yourself

Strong and sudden urge to urinate

Leaking of urine at rest

Difficulty or discomfort w/ passing urine

Uncontrollable gas

Leaking of feces

Straining during bowel movements

Pain in the perineum during sexual intercourse (or any other time)

Unexplained bleeding during or after exercise

Your training

In general, what are your goals for training right now? Check all that apply.

Rehab & recover from pregnancy & birth

Rebuild or improve strength

Rebuild or improve aerobic fitness

Reduce or prevent aches and pains

Improve core & pelvic floor function

Feel less stressed or anxious

Improve or manage my mental health

Feel more in control

Have fun

Improve overall health

Change body composition

Other:

Out of the goals you checked, which ones feel most important? Rank your top 3

What was your exercise routine like before becoming pregnant? How many times per week did you exercise, and what types of exercise did you do?

What was your exercise routine like while you were pregnant? How many times per week did you exercise, and what types of exercise did you do?

Is there anything you want to change about how you exercise moving forward, compared to how you trained pre-pregnancy and during pregnancy? Are there any activities you want to resume/start?

Past birth experience(s)

Have you given birth before your most recent child?

We are aware that not all previous birth experiences may have been positive, but if you have any of these that you feel are relevant and you are comfortable sharing then please do

Have you experienced birth in the past?

Date(s) of birth:

Birth type(s)

Did you experience any tearing?

Is there anything else you want me to know about your past birth experience(s)?

Is there anything else you want to share that you haven’t been asked yet?

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