Doctor Waiver

Doctor Waiver

Your patient:
(fill in name) is beginning a health and wellness program with Satin Wellness In Home Personal Training.

  • Cardiovascular exercise (i.e. treadmill, exercise bicycle, stair climber, elliptical, walking or running)
  • Strength training with hand weights/resistance tubes/ankle weights - trainer assisted
  • Abdominal exercises with supported cervical/lumbar spine
  • Other:

If your patient is taking any MEDICATIONS that could/will affect his/her heart rate or response to any exercise, please list below and indicate the effect.

Medication(s): ---------------------------------------------------------------------------------------------------------

Effect (i.e.: HR, HR): --------------------------------------------------------------------------------------------------

Please identify any recommendations or restrictions that are appropriate for your patient in an exercise program:----------------------------------------------------------------------------------------------------
has my approval to begin/ continued an exercise program with recommendations or restrictions stated above.

Steve Satin, President and Founder

Satin Wellness, Inc.

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