Med-Fit Scores & ExRx

Med-Fit Scores & Exercise Rx

Instructions: Submit the form below after completing your free baseline Medical-Fitness Assessment at your local Med-Fit Clinic.

* Indicates required field

Name: *

First

Last

Email: *

Name of Med-Fit Clinic: *

Date of Med-Fit Assessment *

Gender: *

Male Female

Age: *

Height: *

Weight: *

Body Mass Index (BMI): *

Aerobic Endurance Format: *

Outdoor Shuttle Indoor Treadmill

Score on 4-Minute Jog/Walk: *

Score on 3-Minute Squats: *

Score on 2-Minute Leg-Raises: *

Score on 1-Minute Push-Ups: *

Overall Fitness Score: *

Exercise Rx: *

Write a brief Review of your initial (baseline) Med-Fit Assessment experience: *

Submit