PT on the Net Research

Physicians Approval


TO: ______________________________________________      _____________________________
              Certified Personal Trainer                             Phone Number


________________________________________ has been examined by me and has my approval to participate in a
                      Participant’s Name
progressive exercise program. I understand the physical and physiological stressors of the program and see no reason why the above named person should not participate.

_______________________________________________________________M.D.

_________________________________________                          _______________________
           Physician’s Signature                                   Date


Fitness Program Frequency Intensity Time Type
Cardiovascular
Resistance Training
Flexibility
Other

Physician's Recommendations/Contraindications:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

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