STRICTLY PRIVATE AND CONFIDENTIAL
Consult your doctor for confirmation regarding your suitability for supervised activity to meet your specific needs. Tell your doctor which questions
you answered "Yes" to.
If you have already consulted with your doctor with regard to this/these conditions(s) and you have been cleared to exercise then complete the
It has been confirmed by my doctor that it is suitable for me to undertake supervised moderate activity on a graduated exercise programme.