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For a printable Moms Into Fitness™ Doctor's Note of Approval Form click here.
Doctor’s Note of Approval
This form is intended for the Health Care Provider’s consent
for you to participate in Moms Into Fitness™ activities and exercises.
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Patient’s Name
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Date
I consent to the above named patient’s participation in the
Moms Into Fitness™ exercises and activities. These exercises and activities
include, but are not limited to, 1st Trimester with Lindsay Brin workout DVD,
2nd Trimester with Lindsay Brin workout DVD, 3rd Trimester with Lindsay Brin
workout DVD, Postnatal Boot Camp workout DVD with Lindsay Brin,
Lindsay Brin’s Boot Camp 2, Core Fitness for Moms, Moms Into Nutrition guide
and Stroller Pump.
The prenatal DVD’s include 25-35 minute interval workouts
using aerobics and moderate strength training, as well as a 20-25 minute
prenatal yoga segment. The 1st Trimester DVD includes an optional core section,
2nd and 3rd trimester also include optional core sections but do not include any
supine positions. The Boot Camp DVDs include ten minute interval training
workouts using weights, kickboxing and body resistance training as well as three
minute core segments using Pilates and floor work. Core Fitness for Moms includes
cardiovascular and strength training based on using the pelvic floor and transverse
abdominus. Moms Into Nutrition by Stephanie Young, R.D. includes tips on preparing
your body for pregnancy, eating for mom and baby and losing the baby weight postpartum.
Stroller Pump is a postnatal activity for mom and baby. Exercises include body
resistance training, resistance training, aerobics and core training for mom.
All pregnant women are reminded throughout the DVD’s to stay between a 5 & 8
(American Council on Exercise) on the Modified Borg Scale. This scale is on the
following page. For further information on Moms Into Fitness™ exercises and
activities please contact Lindsay Brin, Creative Director & Vice President of
Moms Into Fitness at lindsaybrin@momsintofitness.com.
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Physician’s Signature
________________
Date
_______________________________________________
Physician’s Name (Please Print)
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