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.
Question 1 of 12
Welcome to the EMP! Are you Pregnant or Postnatal?
Pregnant
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?
Vaginal Birth
Elective C-Section
Open to Either
Question 4 of 12
Postnatal Mummas, what type of birth did you have?
Vaginal Birth with Forceps
Vaginal Birth with Vacuum (Ventouse)
Planned C-Section
Emergency C-Section
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).
Not sure
No tearing
An episiotomy was performed
First to Second Degree Tearing
Third Degree Tearing
Fourth Degree Tearing
Question 6 of 12
Please tell us about your pregnancy and motherhood journey. You may select more than one answer.
First ongoing Pregnancy / Baby
I have one older child.
I have two older children.
I have three or more older children.
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
Abdominal Separation
Back Pain
Pubic or Pelvic Pain
Urinary incontinence
Prolapse
Feelings of vaginal heaviness
Pain during intercourse
Fecal incontinence
Pregnancy or Postnatal Anxiety or Depression
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?
Word of Mouth
Professional Referral
Social Media
Google
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?