Medical Clearance Form 1Medical Clearance Form 1
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Dear Doctor:
Your patient
has applied for enrollment in a fitness testing
and/or a structured exercise program at their worksite. As a participant in this program, she/he may be
participating in the activities named below. Under the American College of Sports Medicine guidelines,
medical clearance has been requested for the following reasons:
Fitness Testing: The purpose of fitness testing is to assess cardiorespiratory fitness, muscular strength and
endurance, body composition, and flexibility. The cardiorespiratory test is a submaximal test utilizing a
cycle ergometer, bench stepping, a treadmill walk/run test, or similar test. Muscular strength and
endurance tests require body calisthenics and/or use of exercise equipment such as a bench press. Body
composition analysis is performed via skinfold calipers, bioelectric impedance, and/or tape measurement.
Flexibility testing utilizes active movements as the straight leg raising test and sit and reach te