Postnatal and Pilates Baby Massage Booking form
Please complete this form if you would like further information or would like to book the postnatal 1-2-1 apt, a baby massage class or baby friendly Pilates class. Please call or text me if you have any questions that you need answered: 087-2115150. Adeline
Where are you based.
Please select where you are based.
When did your baby arrive i.e. your Baby's Birthday
Which classes are you interested in joining or getting further information about?
Baby Massage in Celbridge €100 for 5 two hour classes (Usually on Mondays@12)
Baby Massage in Maynooth €100 for 5 two hour classes (Usually on Thursday@10am)
Baby Massage in either Celbridge or Maynooth on Wednesdays @11 for 5 two hour classes (This class runs if Monday and Thursday classes are full)
Baby/Child Friendly Beginners Pilates class: €100 for 8 classes (Monday@10am or Tuesday@12.30pm) includes 1-2-1. Celbridge only
Adult only Beginners Pilates €100 for 8/10 classes (Monday@6.15 or Tuesday@9pm) includes 1-2-1.Celbridge only,
Repeating Baby Massage or Beginners pilates for free if you have attended both Baby Massage and Beginners Pilates in the same 6 months
Can you let me know why you would like to attend Baby Massage.
Is this your first Baby?
What is your Baby's name?
Has the Baby any special needs or is your baby being Medically Monitored?
If you are interested in attending a beginners pilates class please give as much info about your labour and how you have got on since your delivery.
Also did you have any pregnancy issues that are relevant?
Type of Delivery, Vaginal or Section or emergency section?
Pain Relief Used?
Duration at home, in hospital, pushing?
Did you need any assistance (e.g. forceps)?
Do you have stitches?
What are your concerns now?
What would you like to achieve from this 1-2-1 appointment?
2) Are there part of your job that give you pain? e.g. back pain, neck and shoulder tension etc.
Where did you hear about the classes?
Someone attending the classes at the moment
Someone who attended the classes in the past
Referral from Physio
Referral from Doctor or midwite
Advertisement in Medical Centre or Pharmacy (main st or tesco shopping centre)
Word of mouth
Referral from another class or group I'm attending e.g. breast feeding group
I attended previous classes
Had been attending the practice for Physio/Hydro
Do Not Fill This Out