1.What Active Ostomates class(es) are you registering for?

Mindfulness and Meditation

Pilates

Chair Yoga

Yoga

2.What is your full name?

3.What are your primary goals for joining this Active Ostomates class?

To learn what exercises are safe to do with a stoma

To enhance flexibility

To help myself gently recover from stoma surgery

To improve my confidence

To improve my energy levels

To improve my motivation to be active

To push myself out of my comfort zone

To keep my muscles strong

To support my physical health

To support my mental heatlh

Social interaction

Stress relief

Parastomal hernia management

Other (please specify):

4.How would you rate your current fitness level?

Very poor

Poor

Fair

Good

Very good

Excellent

5.How would you rate your current motivation level to be active?

Very low

Low

Moderate

High

Very high

6.What are you looking forward to most about these classes?

*7.By submitting this survey you are confirming that you are physically fit enough to participate in these sessions. If you have any medical conditions, injuries or are taking any medications that affect your heart rate then please seek advice from a healthcare professional prior to registering. Participation in these workouts are therefore on the understanding that if any injuries occur as a result of the workouts, then Colostomy UK are released from any liability now or in the future for conditions that may be acquired from participation.

If you need to tell us anything before you participate, please contact getinvolved@colostomyuk.org.(Required.)

I understand