Informed Consent

1. Purpose and Explanation - Our medical-fitness tests are "sub-maximal" involving a series of basic exercises based on your age, gender, and fitness level. The objective of the fitness test is to determine your functional capacity, establish an appropriate exercise prescription, and track your progress towards your medical-fitness goals. You are expected to set your own pace to whatever intensity level is comfortable for you. You may stop the fitness test at any time for any reason. The Sports Medicine Technician that administers your test may encourage you to slow-down, or may insist that you stop, depending on the signs of exertion or discomfort that you exhibit during your participation. The general recommendation is to test your fitness every one to three months in order to track your progress and up-date your Exercise Rx, however, your participation is always voluntary.
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2. Attendant Risks and Discomforts - There is the possibility of certain physiological changes occurring during your fitness test. These include: shortness of breath, pounding heart beats, palpitations, dizziness, fatigue, impaired coordination, and in extremely rare instances, heart attack, stroke, or death. Every effort will be made to minimize these risks by thoroughly evaluating your health status and carefully observing your response. Your Sports Medicine Technician has been trained in CPR and emergency procedures.

3. Responsibilities of the Participant - It is important for you to disclose to the Sports Medicine Technician that administers your fitness test all the information regarding your health status and any previous experiences of heart-related symptoms, such as: shortness of breath, pain, pressure, tightness, and/or heaviness in the chest, neck, jaw, back, and/or arms. Your immediate reporting of these or any other unusual symptoms during your fitness test is critically important. You are fully responsible for disclosing your past medical history, current heart-related medications, and any and all symptoms that you experience.

4. Benefits to Be Expected - Your fitness test will result in obtaining an accurate Medical-Fitness Score for determining a medically appropriate Exercise Rx. Your Medical-Fitness Score reflects a) your functional capacity, b) the effectiveness of your exercise program, and c) your progress towards your health and fitness goals. If applicable, your doctor may use your Medical-Fitness Score to better manage sedentary-related medical conditions in conjunction with your on-going treatment. Also, aggregate data will be analyzed and reported for the advancement of exercise science and sports medicine.
    5. Inquiries - You, your doctor, and your personal trainer are welcome to ask questions about the procedures and/or results of your Medical-Fitness Test(s). You are encouraged to get any desired clarifications from your Sports Medicine Technician.

    ​If you have any questions at this time, write them in the space to the right and have your Sports Medicine Technician address them to your satisfaction. If no questions, please indicate "None."
    6. Use of Personal Information - The information that is obtained from your Medical-Fitness Test(s) will be treated as privileged and confidential. It will not be released or revealed to anyone. Aggregate information will be used for statistical analysis and scientific research purposes while fully protecting your identity and right to privacy. Of course, you are always free to share the results of your Medical-Fitness Test(s) with anyone you choose to do so, such as your doctor, personal trainer, family, and friends.

    7. Freedom of Consent - Entering your Name and today's Date below acknowledges that you hereby consent to voluntarily participate in our Medical-Fitness Testing protocol. You understand that you are free to stop the fitness testing at any time. You understand the intent of the procedures and their attendant risks and potential discomforts, and that you had the opportunity to ask questions and get answers to your satisfaction.