Postnatal PAR-Q If you are planning to join the training of FitnessByMaria, start by answering the questions below. Please read the questions carefully and answer each one honestly: Check - YES or NO. Full name Date of birth (dd-mm-yyyy) Post-Natal Health Checklist Setting Boundaries Throughout our coaching partnership, there may be things that come up that you are or are not comfortable talking about. Topics such as your menstrual cycle (or lack thereof), pelvic floor health, nutrition, sleep, and stress may all have an impact on your training and your results to varying degrees. Please indicate which topics you are comfortable talking about with me as your coach by checking the box (or check the first box if you are comfort- able talking about all of them). If you are not comfortable talking about these issues with me, leave the box blank. (Please note you may change your decision at any time). As you go through the rest of this form, feel free to leave the questions that you do not feel comfortable answering blank. I am comfortable talking about any of the topics below: Birth experience YesNo Menstrual cycle YesNo Pelvic floor health YesNo Diastasis recti YesNo Incontinence YesNo Pelvic organ prolapse YesNo C-section recovery YesNo Breastfeeding YesNo Menopause YesNo PART 1: GENERAL HEALTH STATUS Date(s) of birth (dd-mm-yyyy, dd-mm-yyyy) Number of pregnancies Birth type (vaginal/assisted/c-section) Tearing (degree if known) Postnatal bleeding status: Other complications if any: Sleep YesNo Stress YesNo Emotional issues (e.g., depression, anxiety) YesNo Body image YesNo Nutrition YesNo Weight YesNo Other (please list): Have you had your six-week check with your GP?: YesNo If yes, date of appointment (dd-mm-yyyy): Did your GP clear you for exercise? YesNo Did your GP recommend any limitations for your exercise?: YesNo Breastfeeding status: Current activity level Have you met with any of the following health care professionals during or after your pregnancy? Physiotherapists YesNo Acupuncturists YesNo Chiropractors YesNo Other (please specify): Please describe reasons for your visit(s): Do/have you experienced any of the following? If so, please provide relevant details (start date, any treatment(s), current status) in the space provided... MUSCULOSKELETAL Pain in the central pubic area YesNo Lower back pain or sciatica – location: Neck pain YesNo Coccyx (tailbone) damage or pain YesNo Knee pain YesNo Any other joint pain (e.g., wrist) – please specify: Women's health Heaviness, dragging, or bulging in the pelvic area YesNo Diagnosis of pelvic organ prolapse (uterus/bladder/rectum/vaginal) YesNo Leaking urine when you cough/sneeze/exercise YesNo Strong and sudden urge to urinate YesNo Leaking of urine YesNo Difficulty or discomfort with passing urine YesNo Uncontrollable gas YesNo Leaking of feces YesNo Straining during bowel movements (constipation) YesNo Pain in the perineum during sexual intercourse (or any other time) YesNo Unexplained bleeding during or after exercise YesNo Other Hemorrhoids YesNo Varicose veins YesNo Constipation YesNo Gestational diabetes YesNo High blood pressure YesNo Low blood pressure YesNo Lifestyle The purpose of the following questions is to help me, as your coach, get a better understanding of your lifestyle. Sleep, nutrition, hydration and stress, as they all affect your training and recovery. When I have a better understanding of these factors, I can modify your workouts accordingly to ensure recovery. It also helps us work together - to make sure your program leaves you feeling strong and energized. How much sleep do you get in a 24-hour period? How much water do you drink in a 24-hour period? Rate your general stress level on a scale of 1–10 (1=little, 10=extreme): Do you feel depressed or anxious, or do you suffer from mood swings? Have you ever been diagnosed with depression or anxiety?