Get Cardiac Rehabilitation - Phase Iii Bintake Formb - Hamilton Area Ymca - Hamiltonymca

Completing the cardiac rehabilitation - phase III intake form is an essential step for individuals seeking to participate in this vital health program. This guide will provide you with clear, step-by-step instructions to ensure you fill out the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by entering your personal information, including your name, today's date, date of birth, age, preferred phone number, alternate phone number, and email address. Make sure all entries are accurate to facilitate communication.
3. Fill in the emergency contact section with the contact's name, relationship to you, preferred phone number, and alternate phone number, ensuring the information provided is up to date.
4. Provide the details of your primary physician, including their name and phone number. If applicable, list any other physicians involved in your care, using the space provided or the reverse side of the form.
5. Indicate how you learned about the program by providing a brief description in the designated area.
6. Answer the medical history questions by checking 'Yes' or 'No' for each listed health issue. If you answer 'Yes' to any question, include a brief description of the condition in the space provided.
7. List your current medications, including vitamins and over-the-counter drugs. Provide a summary of your current health status by checking one of the options: excellent, good, fair, or poor.
8. Describe your regular exercise habits, including types of exercise and frequency. If applicable, indicate any physical limitations that may affect your daily activities or ability to exercise.
9. State your current employment status and describe your level of activity at work. Provide details about past experience with resistance training and aerobic training.
10. Address any concerns regarding starting the exercise program and outline your expectations for participation.
11. Finally, reflect on how you will assess your personal success and satisfaction with this program before completing the form.
12. Once you have filled out all sections, save your changes, download the form, print it, or share it as required.

Complete your form online to begin your journey in cardiac rehabilitation today!