MOTHER & BABY EVALUATION

Name

Date of Birth

Home Postcode

Venue
—Please choose an option—Anfield Children's CentreCastlefields Community CentreDingle Lane Children's CentreFrank Myler PavilionKensington Children's CentreLiverpool Women's HospitalWalton Children's CentreOther
Course Date
—Please choose an option—Jan - FebMarch - AprilApril - MayJune - JulyJuly - AugSept -OctNov - Dec

DID YOU ENJOY MAMAFIT® MOTHER & BABY?
YesNo

ON A 1-5 SCALE HOW CONFIDENT WOULD YOU SAY YOU ARE ABOUT EXERCISING AS MUM
1 No Confidence2345 Very Confident

WILL YOU CONTINUE TO EXERCISE AFTER THE COURSE?
YesNo

HAS ATTENDING MAMAFIT ® HAD AN IMPACT ON YOUR HEALTH?
NO CHANGE IN HEALTHIMPROVEMENT IN HEALTHDECLINE IN HEALTH

WHICH AREAS OF THE COURSE DID YOU FIND MOST HELPFUL? PLEASE TICK AS MANY AS APPROPRIATE
ADVICE ON POSTUREPELVIC FLOOR EXERCISESHEALTHY EATING INFORMATIONSAFE EXERCISE ADVICEABDOMINAL EXERCISESLOWER BACK EXERCISESUPPERBODY EXERCISESLOWERBODY EXERCISESSTRETCHINGBRINGING BABY ALONGLIFESTYLE TIPSRELAXATION ADVICEMEETING OTHER MUMSPERSONAL SUPPORT

OTHER – PLEASE STATE

WERE THERE ANY AREAS OF THE COURSE YOU DID NOT ENJOY?

IS THERE ANYTHING YOU WOULD LIKE TO SEE INCLUDED IN FUTURE MAMAFIT® MOTHER & BABY COURSES THAT WAS NOT COVERED ON THIS COURSE?

DID YOU COMPLETE THE FULL COURSE? IF YOU DID NOT COMPLETE THE FULL COURSE WHAT WAS THE REASON WHY?
COMPLETED FULL COURSECOULD NOT GET TIME OFF WORKBABY NOT WELLATTENDING OTHER CLASSILL HEALTHWORK COMMITMENTSPERSONAL COMMITMENTSMEDICAL APPOINTMENTSHOLIDAYDID NOT ENJOY THE CLASSES

OTHER – PLEASE STATE

ADDITIONAL COMMENTS

HOW MANY DAYS PER WEEK ARE YOU CURRENTLY ACTIVE FOR 10 MINUTES OR MORE?
1234567

ON THOSE DAYS HOW MANY MINUTES ARE YOU ACTIVE FOR ON AVERAGE?
10-1920-2930-5960+N/A

HOW MANY PORTIONS OF FRUIT AND VEGETABLES DO YOU EAT PER DAY ON AVERAGE?
012345+

HOW MANY DAYS PER WEEK DO YOU NOT EAT BREAKFAST?
0123+

DO YOU CURRENTLY SMOKE?
NOSOMETIMESOFTENDAILY

DO YOU CURRENTLY DRINK ALCOHOL?
NOSOMETIMESOFTENDAILY

I’VE BEEN FEELING OPTIMISTIC ABOUT THE FUTURE
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN FEELING USEFUL
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN FEELING RELAXED
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’ve been feeling interested in other people
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE HAD ENERGY TO SPARE
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN DEALING WITH PROBLEMS WELL
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN THINKING CLEARLY
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN FEELING GOOD ABOUT MYSELF
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN FEELING CLOSE TO OTHER PEOPLE
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN FEELING CONFIDENT
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN ABLE TO MAKE UP MY OWN MIND ABOUT THINGS
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN FEELING LOVED
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN INTERESTED IN NEW THINGS
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

I’VE BEEN FEELING CHEERFUL
1 NONE OF THE TIME2 RARELY3 SOME OF THE TIME4 OFTEN5 ALL OF THE TIME

THINKING ABOUT HOW MUCH CONTACT YOU’VE HAD WITH PEOPLE YOU LIKE, WHICH OF THE FOLLOWING STATEMENTS BEST DESCRIBES YOUR SOCIAL SITUATION

I HAVE AS MUCH SOCIAL CONTACT AS I WANT WITH PEOPLE I LIKEI HAVE ENOUGH SOCIAL CONTACT WITH PEOPLEI HAVE SOME SOCIAL CONTACT WITH PEOPLE, BUT NOT ENOUGHI HAVE LITTLE SOCIAL CONTACT WITH PEOPLE AND FEEL LONELY

WOULD YOU RECOMMEND MAMAFIT® MOTHER & BABY TO OTHER MUMS?
YESNO

WOULD YOU BE INTERESTED IN JOINING MAMAFIT® GO - OUTDOOR RUNNING FITNESS GROUP FOR BUMPS, BABIES & BUGGYS
YESNO

ON A 1 – 10 SCALE HOW WOULD YOU RATE MAMAFIT ® OVERALL?
12345678910