Follow the steps to complete the form efficiently

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Enter the patient's details in the designated fields. This includes their name, address, telephone number, date of birth, NHS number, date, and gender.
3. Provide the referrer’s information. This should include the referrer’s name, address, telephone number, and fax number.
4. Fill in the clinical information section. Input the baseline measurements such as resting heart rate, resting blood pressure (BP), and body mass index (BMI).
5. List all relevant medications the patient is currently taking. Ensure that this information is accurate and up to date.
6. Identify any contraindications for exercise by checking the appropriate fields and providing details if necessary.
7. Select the reason for referral from the available options, including diabetes types, musculoskeletal issues, respiratory diseases, and others. Specify any learning or physical disabilities as needed.
8. Complete the exercise location section, referencing the two locations mentioned for further details about the program.
9. In the authorization section, the practitioner must confirm that the information provided is accurate and that the patient has no contraindications to exercise. The practitioner should then sign and date the referral.
10. Review all entries for accuracy, then save changes. You may also download, print, or share the completed form as needed.

Complete your documents online today to facilitate your exercise referral!