Client Questionnaire

Thank you so much for filling in this form. The information helps us know you better, keep you safe in class, and to learn more about our clients in general so we can improve our service. All information is strictly confidential and shall not be passed on to any third parties.

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Thank you for your response. ✨

Name

Phone

Date of Birth (YYYY-MM-DD)

Postcode

Due Date or Baby’s Birthdate (YYYY-MM-DD)

If you have given birth in the last twelve months, what was the method of delivery?

Vaginal C-section

How did you hear about us?

Have you got any medical conditions/injuries that may affect your yoga/pilates/fitness practise? Please give details.

(If attending a Mum & Baby class) Has your baby got any medical conditions/injuries that may affect them in the class? Please give details.

Are you happy to be photographed during the class and for the photographs to be used on social media.

Yes, both me and my baby No thank you Just me, not my baby (we will ensure you are in the background and will take no facial or close up shots of your baby) Just my baby, not me

Please provide an emergency contact name and number.

I am happy to be occasionally contacted again with offers and news from Mama2shape.

Thank you for your response. ✨

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