Dr smart

GJ Athletics

Smart institute medical centre

Glenn Johnston

Deakin ACT 219

29 renny place

02 6245643

0418665343

RE: SEEKING CLEARANCE TO EXERCISE FOR (Mrs Lumbar _______

Dear Dr _________smart _________,

I am writing to you in regards to a current patient of yours, lumbar vert_______. On
21/10/2013 I conducted a fitness assessment for Mrs lumbar Vert_________. As a result of
this ________Mrs. Lumbar___________ has been classified as above low risk for
participating in an exercise program. This is based on;

______2 weeks of lower back pain __________________

_________slightly tingling down the back of her leg and foot_______________
__________current medicine endome and Celebrex ______________
________________________

To help address these points and improve general health and wellbeing we would like to
prescribe ______rehab program _____________ with a physical activity program. The
implementation of this program will be fully supervised by myself (a qualified gym instructor)
and a teacher from CIT at all times.
I have planned a light intensity program for ______Mrs. lumbar_____________. This
program consists of _______________rehab and strength lower back
_______________________. It would be greatly appreciated if you could review this and
respond to me at the details below.
If you have any questions dont hesitate to contact me;
Phone: 0412345432
Fax: 024333455
E-mail: Gj_athletics@hotmail.com

Yours sincerely,
(Signature)
Glenn Johnston