Please register with Eureka Hydrotherapy

Please fill in the relevant details below to complete your pregnancy profile. We will then know in advance if you or your baby have any health concerns that might need to be discussed further before commencing class. Once you have registered with Eureka Hydrotherapy you can come as often as you like until you have your baby. If you no longer want your place reserved please contact me with feedback as you wish.

At some point in the future we hope to integrate an on-line class booking/payment system, but for now, register once and come as often as you can, to any venue, you’ll feel the benefits!

You only need to fill out this form if you are signing up  for your first class with Eureka Hydrotherapy. All information is kept in strictest confidence. No payment is required until you arrive at class.

A printed version is provided at your first class if you prefer.

Your First Name (required)

Your Surname (required)

Your Date of Birth (required)

Your Address (required)

Your Email (required)

Your Mobile Phone Number (required)

Please type in the following format +353871234567 for easier communications. Thanks!

Your Emergency Contact Number (required)

Which venue will you be attending please?

Your Due Date (required)
You must be at least 16 weeks pregnant to participate in the class. Thanks!

Your GP's name

Your Consultant's name

Your Physio's name

Where are you planning to give birth?

Is this your
1st baby?2nd baby?3rd baby?4th or subsequent child?

What are the ages of your other children?

What is your current occupation?

Are you a happy swimmer? YesNo

Any problems in this pregnancy? (e.g. haemorrhoids, varicose veins, bleeding. low lying placenta, diabetes, infection etc.) NoYes

How is your general health?

How did you hear about these classes?
Word of mouthFlyerGoogle searchTurtle TotsDiscussion forumNewspaper articleHealth professional

I agree, for my own safety and well-being, to inform the teacher at the beginning of the class, should any changes in the above information occur, or if any medical, physical, or emotional problem arise at any time during my class attendance.