Certain conditions require Physician Referral Form
Certain conditions require the completion of our Physician Referral Form. You are required to provide a completed referral form if:
- you are male, age 45 and over
- you are female, age 55 and over
- you are on blood pressure medication
- you have ever had any cardiovascular disease
- you have a seizure disorder
- you have had a stroke
- you have Type 1 or Type 2 diabetes
May Require Physician Referral Form after fitness evaluation
We may require a completed Physician Referral Form if we become aware of any of these situations during your fitness evaluation:
- Systolic blood pressure greater than or equal to 160
- Diastolic blood pressure greater than or equal to 100
- Resting heart rate greater than or equal to 100
- A combination of information (i.e., current blood pressure, cholesterol level, percent body fat, orthopedic problems, etc).
If you require the completion of our Physician Referral Form, we can expedite the process by faxing the form to your physician. Your physician will then fax the form directly to the Fitness Center.
Download HIPPA Form
Download Physician Referral Form
Physician Referral Forms may not be hand delivered to the Fitness Center.
New members must complete a fitness evaluation
After you register with MCC, call the Fitness Center at (815) 455-8551 to schedule your fitness evaluation and one-on-one training session.
The fitness evaluation is a computerized assessment that takes about 30 minutes and evaluates heart rate, blood pressure, body weight, body composition, biceps strength, flexibility and sub-maximal aerobic fitness. Aside from being fun, the profile will assess individual strengths and weaknesses and will assist in the development of an individualized fitness program.
Instructions for the fitness evaluation:
- Wear tennis shoes
- Wear loose fitting shorts and t-shirt. You may wear a sweatshirt and sweat pants to the test, but will need to remove them before the test. Please do not wear stretch shorts that go below the knees.
- Do not eat, smoke or consume caffeine two hours prior to the test.