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11:07 PM
Tuesday 18 August
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Fiona Chan

+61458312550 · fionachan93@gmail.com
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🩹 📋 From form: • No doctor clearance for exercise program yet — obtain before starting • G6PD (high-risk classification) — clarify exercise restrictions with care provider • Fatigue and back pain • Urge incontinence — needs assessment and pelvic floor consideration • Goals: ease back pain, prepare for easier birth • First pregnancy • Care provider: RHH
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Sun 10:00 am · Empower Your Pregnancy (11wk from 23 Aug)
Forms & waivers
Send a form — copy the link and text/email it to Fiona:
Liability Waiver & Acknowledgement 14 Aug 2026
Your name
Fiona
Your email
fionachan93@gmail.com
I have read and agree to the waiver above
I agree
Signed
signature
Fiona Sin Ping Chan
Empower Your Pregnancy — Pre-Exercise Screening 14 Aug 2026
Name
Fiona
Age
32
Occupation
Barista
Email address
fionachan93@gmail.com
Emergency Contact — name and number
0458312550
Have you received clearance from a doctor to be involved in an exercise program?
No
Estimated due date
13/12
Is this your first pregnancy? If not, how many children/pregnancies? Provide details if you feel comfortable
Yes
Pregnancy care provider
RHH
Has a doctor or care provider identified any risk factors or areas of concern in your pregnancy? If yes, please provide details
I was born with G6PD, so they categorise me as a high risk person. But it doesn’t affect my day to day life.
Are you experiencing any nausea, fatigue, pelvic pain or other symptoms that may affect your training?
Fatigue and back pain
If you have had previous births, list DOB and type of birth (vaginal, planned c-section, unplanned c-section, D&C)
/
For your most recent birth, please provide any relevant information (length of labour, pushing phase, tears/episiotomy, assisted delivery, stitches, scar pain/sensation, etc.)
/
For any previous births, please share any details you believe relevant
/
What is your exercise history? What were you doing previously and what have you done in the last 6 months?
Play sports
What are your goals / reasons for training throughout your pregnancy?
Ease my back pain and hoping for an easier birth.
Do you have any concerns about exercising / anything important for me to know? (e.g. previous injuries, pain, fatigue, pelvic girdle pain)
/
Is there anything particular you wish to learn / work with me on?
/
Any other details you wish to share?
/
Have you seen, or do you see, a Women's Health Physio? If yes, what did you go for and what was the result?
/
If you are currently seeing a Women's Health Physio, what is their name and do you consent to me making contact with them?
/
Do any of the following apply?
I experience urge incontinence and/or need to go to the toilet quickly
Have you been assessed for Diastasis Recti (abdominal separation)? If so, when and what was the result?
/
How did you hear about us?
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Do you agree for photographs to be taken during sessions and used on social media for future promotional literature and/or course content?
No
Invoices
$200.00 · Term · due 27 Sep Draft
$240.00 · Term · due 23 Aug Unpaid
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