Pre Assessment Screen

This form is designed as a pre-screen for mothers before a return to activity, as some issues that many feel are simply ‘just being a mum’ can worsen on activity, and left unchecked can increase in severity over time.

However, mums can experience issues related to their pregnancy or labour for years afterwards, so please do complete the form if you are concerned about any area of pelvic health even if it has been a long time since you gave birth.

**Please Note** This form is used by other professionals affiliated with Arcadia Physiotherapy, so please continue to use it if you have been directed to it by them. You will be able to select which professional receives the completed form in question 4. Arcadia will be able to see the details of your form as they will be responsible for passing it forward, but all content will be kept strictly confidential.

The form is, by its nature, asking for very personal details, which we understand you may not yet feel comfortable to disclose. Simply complete the form to the best of your knowledge and comfort level: you can discuss any of these issues further with your specialist during your appointment.

Remember, the more informed we are, the more we can help you.


Thank you very much for completing this form: we look forward to meeting you at your appointment! If you have not yet booked an appointment, simply go to the Booking Page and find a time that works for you.

The goal of Women’s Health Physiotherapy is to help you and your body back to basic strength, function and integrity, so you are then safe, confident and knowledgeable to return to a full healthy and active lifestyle.