INSTRUCTIONS FOR HEALTH SUMMARY
Current Health Information
The Health Summary section below includes your physician's information as well as any allergies or dietary restrictions we should be aware of.
It is important for you to understand how the health information you provide will be used by the YMCA and when it can be disclosed to others. It is important that other YMCA programs in which I participate have access to my health information I complete below and understand that sharing my progress in the Program is essential to my family doctor and to others who are providing treatment to me.
Your agreement and review date at the bottom authorizes YMCA staff and any health care provider listed to access and receive all information about your progress in the Medical Membership Evidence-Based program. Your agreement also confirms that all other information on this page has been reviewed and is accurate and up-to-date.