DISCOVER YOUR PATH TO WELLNESS

At Aurellia, we believe every woman’s journey is unique.

This short questionnaire helps us understand where you are right now – so we can guide you toward the care and movement that best supports your body, mind, and season of life.

(Takes less than 3 minutes to complete)

About You

Full Name

Email

Age Range

Under 25

25–34

35–44

45–54

55+

Your Wellness Goals

Which life stage best describes you right now?

Pregnant

Postpartum (within 12 months)

Parenting young children

Perimenopause / Menopause

General wellbeing / fitness

Recovering from injury or surgery

What brings you to Aurellia? (Select all that apply)

Pregnancy concerns

Prepare for childbirth

Strengthen core or pelvic floor

Manage pregnancy and postpartum changes

Relieve pain or tension (back, neck, hips, etc.)

Improve flexibility or posture

Support hormonal balance or menopause

Reduce stress / improve sleep

Reconnect with my body and confidence

Reconnect with my body and confidence

Specific medical / health issues

Other (Please specify)

What brings you to Aurellia (others textbox)

Areas of Concern or Focus

Are you currently experiencing any of the following? This helps us recommend the most supportive practitioner or class for you.

Pregnancy and delivery

Pelvic floor issues (leakage, heaviness, prolapse)

Abdominal separation (diastasis recti)

Back, pelvic, or hip pain

Fatigue or emotional overwhelm

Weight gain (general or post-partum)

Stress, anxiety, depression or sleep difficulties

Hormonal issues (like hypothyroidism, diabetes, etc.)

Menstrual issues (like PCOS, menstrual concerns, menopause etc.)

Ageing related concerns (like Osteoarthritis, High BP etc.)

Your Preferred Approach to Wellness

Which type of support feels most aligned with you right now?

One-on-one therapeutic care (Physiotherapy or Massage)

Gentle guided movement therapy (Yoga therapy or Pilates)

A combination of therapy and movement

Not sure – I’d like some guidance

Availability & Access

Which type of support feels most aligned with you right now?

Weekdays (morning)

Weekdays (afternoon)

Evenings

Weekends

How would you like to experience our services?

In-person at our Westmead studio

Online (virtual consultations or classes)

A mix of both

Your Wellness Journey

Have you previously seen a women’s health professional (e.g., physio, yoga teacher, or massage therapist)?

Yes

No

If yes, what worked well or didn’t feel right?

Connection & Next Steps

How would you like us to follow up with your personalised recommendations?

Email

Phone call

Text message

Best contact details

Would you like to receive gentle wellness tips and early access to classes or offers?

Yes, please!

Not right now

Final Thoughts

Is there anything else you’d like us to know before your first visit? (Optional)