Please complete this screening form prior to a class or session with Harris Mind & Body.
Please view it as your responsibility to make sure your HMB teacher is fully aware of your current health conditions, so please review this information regularly.
This information is strictly confidential and only used to help us - better help you.
Please note boxes with a * must be completed.
The form will not submit if a * box has been left empty.
We need to ask you some additional information to help us best look after you after your pregnancy. You will notice - much of the form is the same but there is now some extra sections to complete. If you have any questions or concerns please don't hesitate to ask us.