Pre-natal PARQ

Pre-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 any medical advice against excercising or that requires you to modify excercise?

Your Pregnancy

Which tri-mester are you currently in?

How have you been feeling so far during this pregnancy?

Are you experiencing any symptoms or issues that might impact your ability to train?

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?

Your training

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

Maintain or improve strength

Maintain or improve aerobic fitness

Reduce or prevent aches and pains

Improve core & pelvic floor connection

Feel less stressed or anxious

Improve or manage my mental health

Feel more in control

Have fun

Improve overall health

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 now that you are pregnant? How many times per week do you exercise, and what types of exercise do you do?

Past birth experience(s)

Have you given birth before your your current pregnancy?

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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