Exercise Prescription Forms

The following active recovery prescription forms can be used to prescribe a sub-symptom threshold exercise to patients recovering from a concussion. They are intended for clinical use and should always be discussed with your doctor/clinician before starting.

Oculomotor Retraining Exercises

This oculomotor training aims to improve visual endurance and performance and assist in recovering from concussion symptoms over time with eye exercises performed twice daily.

Targeted Heart Rate Exercise Prescription Form for Clinics

This sample target heart rate exercise prescription form is meant to be used in association with an exercise tolerance test, such as the Buffalo Concussion Treadmill Test.

Self-Progressive, graded Exercise Plan for Home

This sample self-progressive exercise prescription form is meant to be used by patients to improve their exercise tolerance using a safe, controlled progressive exercise program.