Postnatal Health Questionnaire

What type of delivery did you have ?

Natural

C-section

Ventouse

Forceps

Did you have episiotomy?

Yes

No

Did you have any stiches ?

Yes

No

Have you had your 6-8 weeks postnatal check up?

Yes

No

Do you have or you ever had any of the following conditions?

Heart condition e.g. heart attack,abnormal ECG, heart palpitations

Pain in your chest when you exercise or do physical activity

High or low blood pressure

Fainting or have spells of dizziness or lose consciousness

Lower back pain

Pelvic pain

Any other spinal conditions

Any other orthopedic condition

Have you been diagnosed with or have a treatmnet the following conditions (Asthma, Diabetes, Epilepsy, Hernia,Stroke, Cancer, Depression)?

No

Yes

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