Dysmenorrhea Exercise Recommendation Form
Please fill out this form to help us recommend suitable exercises for managing discomfort related to dysmenorrhea. All questions are general and do not require sensitive health information.
Full Name
*
First Name
Last Name
Age Range
*
Please Select
Under 18
18-24
25-34
35-44
45 and above
How often do you experience discomfort related to dysmenorrhea?
*
Every cycle
Occasionally
Rarely
Never
How would you describe your usual physical activity level?
*
Sedentary (little or no exercise)
Lightly active (light exercise 1-3 days/week)
Moderately active (moderate exercise 3-5 days/week)
Very active (hard exercise 6-7 days/week)
Which types of exercises do you prefer?
Yoga or stretching
Walking
Aerobic/cardio
Strength training
Other
On a scale of 1 to 10, how intense is your discomfort during your period?
*
No discomfort
1
2
3
4
5
6
7
8
9
Very intense
10
1 is No discomfort, 10 is Very intense
What time of day do you prefer to exercise?
Morning
Afternoon
Evening
No preference
Have you previously tried exercises to help with dysmenorrhea discomfort?
Yes, regularly
Yes, occasionally
No
What is your main goal for exercising during your period?
Reduce discomfort
Improve mood
Maintain routine
Other
Any other comments or preferences regarding exercise recommendations?
Submit
Should be Empty: