Every client is required to fill out a pregnancy parQ before coming for treatment. Please enable JavaScript in your browser to complete this form.Name: *FirstLastDate of Birth: *Contact Number: *Emergency Contact and Number: *Email: *Due Date: *Do you have a low risk pregnancy *YesNoDo you have any of the following conditions: *First Choiceheart or respiratory diseaseIncompetent cervixPersistent bleedingPlacenta praeviaRuptured membranesHypertensionRisk of premature labourPre-eclampsiaHypertheroidismType 1 diabetesHistory of miscarriageAre you experiencing any of these symptoms: *SI joint painLower back painThird ChoicePubis painHip pain (outside of the hip)Rib painRound ligament painIncontinenceBriefly explain the purpose behind your booking: *Please confirm:I have consulted my doctor/midwife before starting any new exercise regime.EmailSubmit Pregnancy ParQ
