Online forms: Cardiac: Referral to exercise

This form has 11 pages

This form is for GPs to refer a cardiac patient to a community exercise class.

Please note, patient must be stable and be six months post cardiac event or procedure.

By submitting this form, you confirm that there is informed consent that the patient:

  • Agrees for the information on this form to be passed on to the exercise instructor
  • Understands that they are responsible for monitoring their own responses during exercise and will inform the instructor of any new or unusual symptoms
  • Will inform the instructor of any changes in their medication and the results of any future investigations or treatment