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Date:

Name:
Exercise Prescription
Stretches:

Hold:
Times per session:
Sessions per day:

Notes:

Exercises:
Frequency:
Sets:

Repetitions:
Weight:
Notes:

Prescribed By:

Dr. Gerald Olin


Dr. Joseph Partyka
Dr. Kerri Brooker

Dr. Tibelius
Christopher Notley CAT(C)
Debora Kenny MT, CFI

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