Useful Antenatal Resources

This form is for people who are currently pregnant.

About you

Please do not continue with this form and contact your GP if:

  • You are losing weight for no reason
  • You are feeling generally unwell or feverish
  • You have recently become unsteady on your feet
  • You have suddenly noticed weakness in any of your muscles, for example you struggle to lift your foot off the floor due to weakness (not pain)

Please do not continue with this form and call NHS 111 if:
You have recently or suddenly developed lower back pain and/or leg pain AND have any of the following symptoms:

  • A change in your bladder function or bowel control (specifically, unable to urinate or bowel incontinence)
  • A change in sensation around your genitals or back passage
  • Loss of sexual function

These symptoms are a possible sign of Cauda Equina Syndrome. This is a condition that requires urgent medical attention. For further information, please read our Cauda Equina Information Card.

Symptoms in Pregnancy

If you have any of the following symptoms then please do not complete this form and instead call your midwife, GP or your local delivery suite Immediately as pelvic health physiotherapy is not appropriate at this time:

  • Persistent severe headaches
  • Any swelling of the face, hands or feet
  • Changes in your sight such as blurred vision or flashing lights
  • Reduction in your baby's movements
  • Itching on the palms of your hands, soles of your feet, shoulders or arms
  • Any recent vaginal bleeding or loss of fluids
  • Severe calf pain or severe pain in your chest
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Patient Details

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You can find this on the NHS app. 

This can also be found on any letter from the NHS like a prescription or appointment letter.

You can also use the following link: https://www.nhs.uk/nhs-services/online-services/find-nhs-number/.

Date of birth Required
Europe/London
Address Required

GP Details

GP Address Required

Contact Details

Please make sure the contact details given are accurate as we will be relying on these to get in touch about arranging an appointment or to find out more information.

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Please note this may be used by a physiotherapist to send information relating to your treatment.

Please select the main reason you are seeking physiotherapy: Required
Is this your first pregnancy? Required
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Have you experienced this problem in a previous pregnancy? Required
If yes, did you have any physiotherapy treatment?

If you are experiencing pregnancy-related back, pelvic girdle or hip pain please complete the following questions:  

Where is your pain? (select all that apply)
If the pain is in your legs, how far down does the pain go? Do you have any pins and needles or numbness?
Any sudden changes in bowel or bladder habits? (specifically, unable to urinate or bowel incontinence)
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