Your name *

First Name

Last Name

Phone *

(###)

###

####

Your Birthdate *

MM

DD

YYYY

Your baby's name *

First Name

Last Name

Your baby's birthdate *

MM

DD

YYYY

Are you a current member of Pursuit Athletic Centre? *

Yes

No

Are you currently seeing a physiotherapist or chiropractor for postpartum recovery? *

Yes

No

Are you currently receiving care at Pursuit Therapy (massage, physio, or chiropractic)? *

Yes

No

How often would you like to attend classes? *

Once a week

Twice a week

Which days of the week would work best for you? *

(Check all that apply)

Monday

Tuesday

Wednesday

Thursday

Friday

How would you describe your current activity level? *

Not very active

Lightly active

Moderately active

Very active

What was your activity level before pregnancy? *

Not very active

Lightly active

Moderately active

Very active