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Prenatal Yoga – Starting form
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Name
*
When is your estimated due date (ET)?
*
If you are over week 30, is baby in a breech position?
*
Yes
No
I am not over week 30
Have you been doing physical activity during this pregnancy?
*
Yes
No
I am just restarting
Are there any conditions why this pregnancy may be at risk and you were asked to stay in bedrest?
*
Yes
No
I am not sure
Have you got any previous experience of premature labour?
*
Yes
No
I am not sure
Are you currently experiencing any of the following?
*
Nausea, vomiting, vertigo, anemia
Swelling, limb numbness
Blood circulation problems, varicose veins
Gestational diabetes
Heartburn
Vaginal bleeding
Placenta previa
Incompetent cervix
Sacro-iliac pain
Back pain
Sciatica
Carpal tunnel
High blood pressure
Low blood pressure
Depression
Anxiety
None of the above
Is there any other injury or surgery, also independent from pregnancy, that we should consider for your yoga practice?
*
Anything else you would like to privately share with me?
*
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