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Get And Sign Physician's Statement Form

______________________________________________________________ For the Physician: Please initial the statement that reflects your evaluation of the above listed person’s fitness for participation in an exercise program. ___ I concur with my patient’s participation, if he/she restricts activities to moderate levels. ___ I DO NOT concur with my patient’s participation. He/she is not medically acceptable to participate and should not be permitted to exercise in your facility at this time. ___...

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