Release & Waiver For Personal Fitness Training Program Page 4

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List Present Medications
__________________________ __________________________ ________________________________________
_________________________________________ __________________________ _________________________
__________________________ _________________________________________ _________________________
Personal Trainer Use Only:
RECOMMENDATIONS/HEALTH STATUS CLASSIFICATION:
______Medical clearance needed ______Apparently health
______Max stress test and medical clearance ______Increased risk
______Refer to medically supervised program ______Known disease
COMMENTS:
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