Kindly fill in the below form. Post Natal 1:1/Group Class Name * First Name Last Name Phone (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Please list any previous births, dates , children(s) names. Any Current Health Issues & Medication. Any past/ existing injuries, complaints? (neck, back, joints, pelvis) How Do you Feel Emotionally/ Mentally? Menstrual Cycle E.g regular, irregular, not returned Are you breastfeeding? (How does your breast tissue feel?) Please state if you have had or get mastitis. Please detail any regular activity/ exercise. How do you feel after exercise/ activities (Running with Kids/Pushing Pram/Shopping Carrying Heavy bags) How does your core feel? How does your pelvic floor feel? (Do you feel heaviness here, state if you note its worse at certain times, days, cycles of month, after a certain activity). Have you experienced/ have any prolapse or piles? What do you hope to get from these 1:1/Group sessions? How would you like to feel after class/ specifically - calm, energised. rested. focused, clarity, less anxious, grounded, stability, strength. What type of practice are you looking to do? Gentle, relaxing, slow, dynamic, injury recovery Is there are certain focus or target area? (backbends, Inversions, hips, back tension release, mobility, upper body strength, balance, Core, Breathing, Pelvic Stability, Pelvic Floor, etc Details of birth experiences/. Following things are helpful to share if you wish to. 1 length of labour 2. How labour started 3. Nature of delivery 4. Environment 5.Pain relief 6. Complications 7. Term of baby8. Any tearing/ sutures Do you have any previous yoga experience? (if yes what style and frequency?) How did you hear about me? I agree to inform Tess at the beginning of each session should any changes appear in the above information, or if any medical, physical, or emotional changes arise while attending the each session. * Thank you!