Postnatal Physio Consent Form

If you are planning to book or have already booked a Physiotherapy Initial Assessment, please complete the below form.

This form is designed for those who gave birth in the last year. If your most recent birth was more than 1 year ago, please complete this form instead.

If you have any questions or issues, please contact

If already back, please give date returned, or N/A if not relevant

The following questions pertain to your recent birth. They are relevant in regards to your hormone levels and overall recovery stage. They may also give further information to help understand and treat your current problem.

eg. Vaginal +/- Ventouse / Forceps or Cesarean
Please include details about any tears / other complications, baby weight(s) etc.