Active Birth Pregnancy Yoga Classes Registration
Pregnancy Yoga
Birmingham
To book your class call
0121 449 9803
or book online
Latest News Letter
Available Here
Name
Due Date
Address
Postcode
Telephone Number
Email
Age
Any other children
Profession
Where do you plan to give birth
Who will be attending the birth
Pubic Pain
Varicose Veins
Back Pains
Nausea
Tiredness
Anxiety
Depression
High Blood Pressure
Low Blood Pressure
Low Placenta
Anaemia
Bleeding
Constipation
Heartburn
Sleeplessness
Numbness
Restless Legs
Breathlessness
Haemorrhoids
Leg Cramps
Other Problems/Allergies
Miscarriages
Terminations
Complications:present or previous
Operations
Past injuries
Tues 7.30-9.00 pm
Wed 10.30 am-12.00
Wed 5.45-7.15pm
Wed 7.45-9.00pm
What date would you like to start
How did you find out about the class
I would like to pay my fees by
By ticking this box, I confirm that for my own safety and well being, I will inform the teacher at the beginning of any class, should any changes in the above information occur, or if any medical, physical, or emotional problems should arise at any time during my Active Birth preparation
General health-Please tick if you suffer from any of the following
Obstetric/Gynae History
Class Preference
Please indicate preference by inserting 1-4 in the boxes, 1 most prefered, 4 least prefered, or put an x in the box if you cannot attend a particular class