Prenatal Intake Form Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Emergency Contact Name & NumberSecond Emergency Contact Name & NumberEstimated Due DatePregnancy Support (check all that apply)OB/GYNMidwifeDoulaOtherMy Current Activity Level isSedentaryActive 2 - 3 Days per weekActive most daysGym RatHow long have you been practicing yoga?This will be my first classI have practiced yoga a few timesLess than 6 months6 - 12 Months1 - 3 YearsGreater than 3 YearsWhat are your goals in practicing yoga? (check all that apply)Labor and Delivery PreparationStress relief/ Peace of MindBetter/ more comfortable sleepTo move and stay activeTo learn breathing techniquesTo improve balance and coordinationTo connect to my babyIf you have any health conditions such as low blood pressure or pre-eclampsia, if you are taking medications that may make you drowsy or unstable, or if you are injured or have any other health considerations, please let me know.Submit Thank you for taking the time to fill out the prenatal intake form. I look forward to seeing you in class!Sarah