Get Physician Release Form 72014

Filling out the Physician Release Form 72014 online is a straightforward process that facilitates the application for Wellness Center membership. This guide will provide you with step-by-step instructions to ensure that you complete the form accurately and efficiently.

Follow the steps to complete the Physician Release Form 72014.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. Begin by entering the patient's full name and date of birth at the top of the form. Ensure this information is accurate, as it is essential for the application process.
3. In the section labeled 'Restriction status,' you will need to indicate whether the patient has any restrictions. If the patient has no restrictions, please initial next to 'Patient has NO restrictions.' If there are restrictions, initial next to 'Has restrictions listed below.'
4. Detail whether the patient requires a supervised exercise program by circling either 'YES' or 'NO.' This will help determine appropriate fitness activities.
5. In the next section, check off any items that the patient is restricted from doing under both Aerobic Exercise Modality and Weight Training Modality. This will help ensure safety while participating in Wellness Center activities.
6. Provide any other remarks or limitations regarding the patient's condition in the designated area. This additional information can assist in tailoring their exercise program.
7. Finally, the physician or provider must sign and date the form. Please ensure you print or stamp your name and office for verification.
8. Once all sections are completed, you can save changes, download, print, or share the form as needed.

Complete the Physician Release Form 72014 online today to facilitate your application for membership.