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Solidly Active Physical Activity Referral Form SECTION 1: Patient Information Full Name:Date of Birth:Address:Postcode:Telephone Number: SECTION 2: Physical Activity Program (please tick) Doc Spot

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How to fill out physical activity referral form

01

Obtain a physical activity referral form from your healthcare provider or local fitness center.

02

Fill out your personal information including name, address, date of birth, and contact information.

03

Provide details about your current health status and any medical conditions that may impact your ability to exercise.

04

Indicate your fitness goals and any specific recommendations from your healthcare provider.

05

Sign and date the form before submitting it to the appropriate party.

Who needs physical activity referral form?

01

Individuals who have medical conditions or health concerns that require guidance from a healthcare provider before starting an exercise program.

02

Patients who have received recommendations from their healthcare provider to participate in physical activity for improved health and well-being.

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What is physical activity referral form?

A physical activity referral form is a document that is used to recommend or prescribe physical activity to an individual by a healthcare provider.

Who is required to file physical activity referral form?

Healthcare providers such as doctors, nurses, or physiotherapists are required to file a physical activity referral form.

How to fill out physical activity referral form?

To fill out a physical activity referral form, the healthcare provider needs to provide details about the individual's health condition, recommended physical activity, duration, and any restrictions.

What is the purpose of physical activity referral form?

The purpose of a physical activity referral form is to encourage individuals to engage in physical activity for health benefits and to help manage certain health conditions.

What information must be reported on physical activity referral form?

Information such as the individual's name, contact information, health condition, recommended physical activities, duration, and any special instructions must be reported on the physical activity referral form.

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