Get Exercise Is Medicine - Etmc

This guide provides clear and supportive instructions on how to fill out the Exercise Is Medicine - ETMC program referral form online. Follow the steps carefully to ensure proper completion and maximize your program experience.

Follow the steps to successfully complete the referral form.

1. Press the ‘Get Form’ button to obtain the Exercise Is Medicine - ETMC form. This will allow you to access the document within your preferred online environment.
2. Begin by filling out the patient name section. Include the full name of the person referred to the program along with their date of birth (DOB) as required.
3. Next, enter the patient's contact information including their phone number and email address. Ensure that these details are accurate to facilitate communication.
4. In the section labeled 'I recommend the above patient participate in the Exercise is Medicine program at the ETMC Olympic Center at Tyler,' make sure this statement accurately reflects the physician's recommendation.
5. In the restrictions section, it is important for the attending physician to provide any necessary exercise limitations for the patient. Make sure this is thoroughly completed.
6. Then, have the physician fill in their name, sign, and date the form. This step is crucial as it validates the referral.
7. Enter the physician's phone number and fax number in the designated fields to ensure easy follow-up communication.
8. Review all provided information for accuracy. Once confirmed, you can choose to save any changes made, download, or print the completed form.
9. Finally, submit the completed form by either faxing it to 903-596-3479 or by presenting it in person to a fitness team member at the ETMC Olympic Center at Tyler.

Complete your Exercise Is Medicine - ETMC program referral form online today!