Council on Aging Fitness Program Medical Clearance Form - chicopeema 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in your personal information, including your last name, first name, date of birth, address, city, state, zip code, phone number, mobile number, and email. Ensure all details are accurate for effective communication.
3. Indicate your age and gender by selecting the appropriate options. Then provide your height and weight to give a complete overview of your physical status.
4. In the medical history section, circle 'YES' or 'NO' for each question regarding past injuries or surgeries. If applicable, list any major injuries or surgeries you have had in the last three years.
5. List any current medications you are taking in the designated area. This is crucial for understanding your health background.
6. Evaluate your diet and stress levels by selecting from the provided options. Additionally, indicate if you smoke and whether you lead a sedentary lifestyle.
7. Provide emergency contact information by listing a person’s name, phone number, and relationship to you.
8. Finally, sign and date the form at the bottom. If required, ensure that a physician completes the medical clearance section before submission.

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