Antenatal Fitness Screening Form

The information collected in this form will be used only for the purpose of designing an appropriate fitness program for you and will not be disclosed to any third party without your consent.

We reserve the right to request a doctor’s clearance before allowing you to receive personal training with Kate Campbell Fitness.

Please fill out the form as thoroughly as possible.

Name *
Name
Address
Address
Due Date
Due Date
Antenatal History
Please Ensure the following information is correct. If you have any previous or current medical conditions, injury or disabilities you may need to speak to your GP or Physiotherapist before you attend. Do any of the following apply to you?
Exercise History
Tick the type of exercise you did regularly before becoming pregnant
How did you hear about Keep Mums Fit
Informed Consent *