Follow-Up Med-Fit Test

Instructions: Submit the form below after completing your Follow-Up Med-Fit Test at your local Med-Fit Clinic. (This should be down approximately 4 weeks after your baseline Medical-Fitness Assessment.)

* Indicates required field

Name: *

First

Last

Email: *

Name of Med-Fit Clinic: *

Date of Follow-Up Med-Fit Test: *

Number of Weeks since your free initial (baseline) Medical-Fitness Assessment: *

Estimate as a Percentile how well you adhered to your Exercise Rx: *

Change in Weight since your initial (baseline) Medical-Fitness Assessment: *

Aerobic Endurance Format: *

Outdoor Shuttle Indoor Treadmill

New Score on 4-Minute Jog/Walk: *

New Score on 3-Minute Squats: *

New Score on 2-Minute Leg-Raises: *

New Score on 1-Minute Push-Ups: *

New Overall Fitness Score: *

Up-Dated Exercise Rx: *

Were the Medical-Fitness Services worth your time, money, and effort? *

Yes Somewhat No

Would you recommend the Medical-Fitness Services to others? *

Yes Selectively No

Write a brief Review of your Follow-Up Med-Fit Test experience: *

Submit

Course Syllabus

OptiHealth Institute

Follow-Up Med-Fit Test

OptiHealth Institute