Postnatal Yoga Assessment Form

Personal Information

Name

Age

Contact Number

Address

Occupation

Emergency Contact

Postpartum Information

How much time has passed since childbirth?

What type of delivery did you have (e.g., vaginal, C-section, assisted delivery)?

Are you experiencing any postnatal health concerns (e.g., diastasis recti, pelvic floor issues, back pain)?

How would you describe your current sleep patterns (e.g., duration, quality, consistency)?

Lifestyle and Wellness

What are your diet preferences (e.g., vegetarian, non-vegetarian, vegan, etc.)?

Do you have a support system at home? If yes, please describe.

How would you describe your current energy levels?

What was your exercise routine like before pregnancy?

Medical History

Have you experienced postpartum depression or anxiety?

Are you currently taking any medications or supplements?

Goals for Fertility Yoga

Are you focusing on physical recovery, stress relief, bonding with your baby, or another goal?