PREGNANCY PRE COURSE QUESTIONNAIRE

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    Name

    Date of Birth

    Postcode

    Venue

    Course Date

    IS THIS YOUR 1ST CHILD?

    IF NO, HOW MANY CHILDREN DO YOU HAVE?

    ON A 1-5 SCALE HOW CONFIDENT WOULD YOU SAY YOU AREABOUT EXERCISING WHILST PREGNANT

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

    ON THOSE DAYS HOW MANY MINUTES ARE YOU ACTIVE FOR ON AVERAGE?

    HOW MANY DAYS PER WEEK WERE YOU ACTIVE FOR 10MINUTES OR MORE BEFORE PREGNANCY?

    ON THOSE DAYS HOW MANY MINUTES ARE YOU ACTIVE FOR ON AVERAGE?

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

    HOW MANY DAYS PER WEEK DO YOU NOT EAT BREAKFAST?

    DO YOU CURRENTLY SMOKE?

    DO YOU CURRENTLY DRINK ALCOHOL?

    THE WARWICK-EDINBURGH MENTAL WELL-BEING SCALE (WEMWBS)
    BELOW ARE SOME STATEMENTS ABOUT FEELINGS AND THOUGHTS; PLEASE CIRCLE THE BOX THAT BEST DESCRIBES YOUR EXPERIENCE OF EACH OVER THE LAST 2 WEEKS

    I’VE BEEN FEELING OPTIMISTIC ABOUT THE FUTURE


    I’VE BEEN FEELING USEFUL


    I’VE BEEN FEELING RELAXED


    I’ve been feeling interested in other people


    I’VE HAD ENERGY TO SPARE


    I’VE BEEN DEALING WITH PROBLEMS WELL


    I’VE BEEN THINKING CLEARLY


    I’VE BEEN FEELING GOOD ABOUT MYSELF


    I’VE BEEN FEELING CLOSE TO OTHER PEOPLE


    I’VE BEEN FEELING CONFIDENT


    I’VE BEEN ABLE TO MAKE UP MY OWN MIND ABOUT THINGS


    I’VE BEEN FEELING LOVED


    I’VE BEEN INTERESTED IN NEW THINGS


    I’VE BEEN FEELING CHEERFUL

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

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