Physician's Exercise Release
I have examined
and have found the following:
____ The above named may participate fully in a progressive physical activity program consisting of cardiovascular, strength and flexibility training without limitiation.
____ The above named may participate in a progressive physical activity program with the following limitations:
Please list any medications that your patient is currently taking that may affect heart rate or blood pressure response to exercise (elevating or suppressing). If none, write "NONE".