We encourage referrals from all healthcare professionals. 
Please take note of the inclusion and exclusion criteria listed below, before completing this form. 

Patient Information 

In my medical/professional opinion, the above-named patient is able to undertake a suitable programme of physical activity. 
The patient has agreed to the release of their medical details to Isle Health Limited. They have been informed that their details will be securely stored in accordance with all privacy regulations, and they agree that Isle Health Limited can contact them by email, telephone, or via encrypted communication apps. 
16 years and older 
Motivated to take part in activity 
Have a long term health condition or at risk of developing one (including mental health) 
Is medically stable 
Exercise would be deemed beneficial to the client by a health care professional 
Acquired brain injury 
Severe or poorly controlled asthma 
Unstable cardiac condition / recent event  
Severe aortic stenosis (symptomatic) 
Resting systolic BP ≥ 180 mmHg 
Acute uncontrolled psychiatric illness  
Terminal illness with rapid progression  
Exercise related hypotension 
Uncontrolled tachycardia (resting ≥ 100 bpm) 
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