Medical Consult Request

Lifestyle Medicine Consult Request

As a registered Fitness Professional with Med-Fit, you may request a Medical Consultation on your clients that have lifestyle-related conditions or chronic disease. Simply complete the form below. Your client will be contacted for a free Lifestyle Medicine Consultation and you'll receive a report of the findings along with medically-appropriate fitness testing and training guidelines.

* Indicates required field

Fitness Professional's Name: *

First

Last

Fitness Professional's Email: *

Please contact my client identified below and schedule a
Lifestyle Medicine Consult as soon as possible. Thank you.

Client's Name: *

First

Last

Client's Email: *

Age: *

Gender: *

BMI: *

WC: *

Med-Fit Test: *

Test Result: *

Med-Fit Score *

Health or Medical Condition(s) of Concern: *

Specific Question(s) that you want addressed: *

Other pertinent information (optional): *

Submit