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Cardiac Therapy Assessment Form

Program Structure Cardiac Rehab

Please Note: Cardiac Rehab is 100% telemedicine, and there are no in-person appointments.



  • 3 Days per Week (Monday, Wednesday, Friday): 1-hour sessions (via Zoom)
  • Class times may vary based on patient skill level and availability
  • Patients submit a Daily Therapy Journal each day – this allows their assigned clinician to continuously monitor their vitals even when they are not in class

Patient Onboarding

Patients have an initial Zoom consultation with their assigned clinician prior to starting 3 days/week cardiac rehab to discuss past medical history and establish a proper treatment plan. Each patient receives a starter kit prior to starting cardiac rehab that contains the necessary equipment needed to participate in class and take their vitals at home – this will contain:

  • Pulse oximeter, exercise bands, pedometer
  • Blood pressure cuffs
  • Weight scale
  • Bluetooth ECG/EKG monitor: this device will allow both patients and LTV clinicians to monitor the real-time results and collect continuous data
  • Living Well with Heart Disease: Workbook (Heart Disease & Rehab, Healthy Eating, Exercise, Taking Medications, Managing Risk Factors and Emotional Health)

Program Length

Our cardiac rehab program is 12 Weeks (36 Sessions):

  • During the initial assessment, patients are given a tentative graduation date based on their starting date in cardiac rehab
  • Upon graduating LTV cardiac rehab, patients have an exit interview with their assigned clinician where they will discuss ways they can continue exercising and staying active

What Happens During Class?

In addition to exercise, our cardiac rehab program educates patients on proper diet and nutrition and teaches them basic stress management techniques. LTV telemedicine cardiac rehab models the same structure each class:

  • Check-in (blood pressure and heart rate check)
  • Warm-up
  • Main exercise
  • Cool down
  • Check-out (blood pressure and heart rate check)

** Each patient will continue to have a monthly follow-up conference with their assigned clinician to assess their progress in cardiac rehab and establish new goals to accomplish during their time in our program

Fax Completed Referral to 800-307-3523 or use the form below

Lifetime Vitality Cardiac Therapy Assessment Form

The Lifetime Vitality Cardiac Therapy Assessment form below is used to collect vital information about your cardiac health and any related conditions you may be facing. The information you provide will play a crucial role in helping us create a personalized therapy plan that aligns with your unique cardiac needs, ensuring you receive the most beneficial and targeted care.


If you have any questions, need further assistance, or wish to consult with one of our specialized cardiac therapists, please do not hesitate to reach out to us. You can email us directly at, and one of our dedicated team members will respond to you promptly. We are here to support you every step of the way on your journey to improved heart health.

    Select Symptoms or Issues (check all that apply)

    What is your current smoking status?

    I have read the Disclosure Agreement, and Agree to the Terms and Conditions of this site. I am well aware of this program and I may be disclosing possible personal information to Lifetime Vitality To formulate an Interactive Therapy program.

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