Executive Medical History UPDATE Form - Inova Health System
Executive Medical History UPDATE Form - Inova Health System
Executive Medical History UPDATE Form - Inova Health System
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Exercise Program Assessment<br />
Patient Name:<br />
Date:<br />
Gym Member?<br />
Gym equipment @ home/work<br />
Do you currently work with a personal trainer? Yes No If yes, frequency:<br />
Injuries/Restrictions<br />
FITNESS GOALS<br />
Increase strength/endurance<br />
Stress management<br />
Disease Management<br />
Type<br />
Race Event<br />
Type<br />
Other<br />
Type<br />
Barriers to exercise:<br />
Additional information you wish to share:<br />
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