check

Where to Start Quiz

Welcome to the Empowered Motherhood Program! We would love for you to take 2 minutes to complete this short assessment so we can guide you to the best place to start your EMP journey with us!

Click the button below to start.

Start

Question 1 of 12

Welcome to the EMP! Are you Pregnant or Postnatal?

A

Pregnant

B

Postnatal

Question 2 of 12

Please let us know how many weeks pregnant/postpartum you are and your due date or birth month. (e.g. 26 weeks pregnant and due in September).

Question 3 of 12

Pregnant Mummas - What type of birth are you planning?

(Select all that apply)
A

Vaginal Birth

B

Elective C-Section

C

Open to Either

Question 4 of 12

Postnatal Mummas, what type of birth did you have?

(Select all that apply)
A

Vaginal Birth

B

Vaginal Birth with Forceps

C

Vaginal Birth with Vacuum (Ventouse)

D

Planned C-Section

E

Emergency C-Section

F

N/A

Question 5 of 12

If you had a vaginal birth, were you aware of any tearing or was an episiotomy performed? (Just select N/A if you gave birth via C-Section).

(Select all that apply)
A

Not sure

B

No tearing

C

An episiotomy was performed

D

First to Second Degree Tearing

E

Third Degree Tearing

F

Fourth Degree Tearing

G

N/A

Question 6 of 12

Please tell us about your pregnancy and motherhood journey. You may select more than one answer.

(Select all that apply)
A

First ongoing Pregnancy / Baby

B

I have one older child.

C

I have two older children.

D

I have three or more older children.

E

I have previously experienced pregnancy or baby loss and would like to also acknowledge the baby or babies that I carried in addition to my answer above.

Question 7 of 12

Are you experiencing any of the following symptoms 

(Select all that apply)
A

Abdominal Separation

B

Back Pain

C

Pubic or Pelvic Pain

D

Urinary incontinence

E

Prolapse

F

Feelings of vaginal heaviness

G

Pain during intercourse

H

Fecal incontinence

I

Pregnancy or Postnatal Anxiety or Depression

J

None of the Above

Question 8 of 12

What types of exercise have you been doing during your pregnancy or if you have returned to exercise after birth.

Question 9 of 12

What is your main reason for joining the EMP? What would you like to get out it?

Question 10 of 12

How did you hear about us?

A

Word of Mouth

B

Professional Referral

C

Social Media

D

Google

E

Other

Question 11 of 12

If professional referral, please let us know their name (and practice if appropriate).

Question 12 of 12

Anything else you think we should know?

Confirm and Submit