YMCA Client Information. As discussed, please click on the button and input your information to help us complete your YMCA Referral. YMCA Referral Form New candiNETWORK Referral - YMCA Positive Health Have you ever been told you need to check with a doctor before you start any exercise? * No Yes If yes, please provide details (N/A if not applicable) * Are you currently taking any Medication? (N/A if not applicable) * If Yes, does that Medication have any Side Effects? (N/A if not applicable) * What is your current Blood Pressure? (if known) CD4 Count (if known) Viral Load (if known) Cholesterol Levels (if known) Lipodystrophy - details of any conditions or medical history Cardiovascular - details of any conditions or medical history Respiratory - details of any conditions or medical history Musculoskeletal - details of any conditions or medical history Weight Loss - details of any conditions or medical history Neurological - details of any conditions or medical history Mental Health - details of any conditions or medical history Any other information or details of medical history that may be useful for YMCA to know? Referral sent to YMCA.
