Please fill in this form before you attend your postnatal class. 

(Please note it is not a referral form. If you wish to refer to the women’s / pelvic health physiotherapy service please fill in the self-referral form). 

Required
Address Required
Required
Required
To enable us to see people in a timely manner, the initial appointment is usual in a group (either virtual or face to face). Do you consent to being seen in a group setting? Required
Required
Required
How was your baby delivered? Required
Did you have an episiotomy (cut)? Required
Required
Do you have any concerns regarding the below?
Would you like to speak to a physio on a 1-1 basis about any of these concerns?
Have you started pelvic floor muscle exercises yet? Required
If you have started your pelvic floors exercises, how confident are you with them?
Required