Clinic template
A Cliniko treatment note template for an exercise physiology initial assessment
This template runs an accredited exercise physiologist through pre-exercise screening using the Adult Pre-Exercise Screening System (APSS) from Exercise & Sport Science Australia, resting vitals, a functional test battery, outcome measures and an exercise prescription, built as a Cliniko treatment note template under Settings. It differs from a physiotherapy initial assessment by screening for exercise risk before any test is run.
Last checked 25 Sep 2026 against the sources listed at the end of this page.
Free template ยท Cliniko
Treatment note: initial assessment: exercise physiology
The template: 23 fields
| Section | Field | Type | Notes |
|---|---|---|---|
| Referral and reason | Referral source | Radio | Cliniko type: Multiple choice. Options: Self / GP (Medicare Chronic Disease Management) / DVA / NDIS / Workers compensation / Private health fund / Other. |
| Referral and reason | Reason for referral or attendance | Paragraph | Presenting condition, and the outcome the patient wants from the program. |
| Referral and reason | Patient goals | Paragraph | In the patient's words. The exercise prescription and review are measured against these. |
| Pre-exercise screening | APSS Stage 1 self-guided screen completed | Radio | Options: Yes, no factors identified / Yes, factors identified / Not completed. Based on the ESSA/SMA/Fitness Australia Adult Pre-Exercise Screening System. |
| Pre-exercise screening | Risk factors identified | Checkboxes | Options: Cardiovascular / Respiratory / Metabolic (including diabetes) / Musculoskeletal / Other medical condition / None. Leave the default answer blank. |
| Pre-exercise screening | Risk stratification outcome | Radio | Options: Proceed with exercise / Proceed with modification / Medical clearance required before starting. Record the reasoning in the next field. |
| Pre-exercise screening | Screening notes and medical clearance | Paragraph | Note any GP clearance obtained, or that it is pending, before the program starts. |
| Vitals and anthropometry | Resting heart rate and blood pressure | Text | Cliniko has no number type, so use Single line text, for example 72 bpm, 128/82. |
| Vitals and anthropometry | Height, weight and waist circumference | Text | |
| Vitals and anthropometry | Current medications relevant to exercise | Paragraph | Include anything affecting heart rate response, blood pressure or blood glucose. |
| Functional and musculoskeletal screen | Posture and movement screen | Paragraph | Observation, gait and any compensations relevant to the exercise program. |
| Functional and musculoskeletal screen | Functional test results | Paragraph | Select tests relevant to the goal, for example sit to stand reps in 30 seconds, timed up and go, grip strength, 6 minute walk distance. |
| Functional and musculoskeletal screen | Pain or limitations during testing | Paragraph | |
| Outcome measures | Outcome measure selected | Checkboxes | Options: 6 minute walk test / 30 second sit to stand / Grip strength / Waist circumference / Patient Specific Functional Scale / Other. Repeat the same measure at review. |
| Outcome measures | Baseline scores | Text | Needed for Medicare CDM and DVA reports that ask for progress against baseline. |
| Assessment | Clinical impression | Paragraph | How the screening, vitals and functional findings shape the exercise approach. |
| Exercise prescription | Program design (mode, frequency, intensity, time) | Paragraph | Written as FITT: mode, sets and reps or duration, intensity, and sessions per week. |
| Exercise prescription | Contraindicated movements or loads | Paragraph | Anything to avoid given the screening or musculoskeletal findings. |
| Exercise prescription | Review and progression date | Text | |
| Consent | Informed consent | Checkboxes | Options: Screening results explained / Program and expected effort explained / Risks of exercise explained / Questions answered / Consent given to proceed. |
| Consent | Consent notes | Paragraph | Anything declined, or any adjustment made at the patient's request. |
| Plan | Home or independent exercise | Paragraph | What the patient will do between sessions, if anything. |
| Plan | Communication to referrer | Paragraph | What will be reported back to the referring GP, and when. |
Build it in Cliniko
- Go to Settings > Treatment note templates as an Administrator, click Add template, and name it Exercise physiology initial assessment.
- Add each section above with Add section, then add its questions using Cliniko's six question types: Paragraph text, Single line text, Multiple choice, Checkboxes, Body chart or Date.
- For the pre-exercise screening section, keep the APSS question as a simple record of the outcome rather than reproducing the full screening tool inside Cliniko. Run the actual APSS as a separate paper or PDF form and file it against the patient, then record the result here.
- Type out the Multiple choice and Checkboxes options exactly as listed in the note column so every practitioner in the clinic sees the same wording.
- Set a default answer only where it saves typing, such as the FITT prescription prompt, and leave risk related checkboxes with no default so nothing is ticked by accident.
- Assign the template to your initial exercise physiology consultation appointment type so it loads automatically.
- Run one test note on a test patient through to a saved PDF, and check the vitals and functional test fields print in a readable layout before the whole clinic uses it.
AHPRA: Accredited exercise physiologists are accredited by Exercise & Sport Science Australia rather than registered under the National Law, so the AHPRA Code of conduct does not apply directly. ESSA's own professional standards ask for the same underlying practice: a documented pre-exercise screen, informed consent, and a record another exercise professional could pick up.
Screening comes before testing, not after
An exercise physiology initial assessment has a step a physiotherapy assessment does not: deciding whether it is safe to load the patient with exercise at all before any functional test is run. This template puts the Adult Pre-Exercise Screening System result first, with its own risk stratification field, so a practitioner cannot skip from referral straight to functional testing without recording that the screen happened and what it found.
The screening question in this template is deliberately a summary field, not a rebuild of the APSS tool inside Cliniko. The actual APSS is a multi-page instrument published by ESSA, Sports Medicine Australia and Fitness Australia, and it is meant to be run and kept as its own document. Cliniko's treatment note templates hold the outcome and the clearance decision, which is what the ongoing clinical record needs.
Why vitals get their own section
Resting heart rate and blood pressure sit in their own section rather than folded into the functional screen because they are the numbers a program has to be built around, and the ones most likely to be needed again quickly if a patient reports symptoms during a later session. Keeping them as short text fields at the top of every initial note means a practitioner reviewing the file does not have to search a long paragraph to find them.
The prescription section is what makes this an EP note, not a physio note
The functional test and outcome measure sections use tests exercise physiologists actually run, such as the 30 second sit to stand and grip strength, rather than the range of movement and special tests a physiotherapy template uses. The exercise prescription field is written around the FITT structure (mode, frequency, intensity, time) because that is how an exercise program is actually delivered and adjusted at review, not as free text description of what happened in one session.
Sources
- The Adult Pre-Exercise Screening System (APSS) Version 2 was developed jointly by Exercise & Sport Science Australia, Sports Medicine Australia and Fitness Australia, and is used to identify people who may be at higher risk of an adverse event during exercise before they start a program. Exercise & Sport Science Australia (ESSA), checked 25 Sep 2026.
- Cliniko treatment note templates support six question types: Paragraph text, Single line text, Multiple choice, Checkboxes, Body charts and Date, built under Settings > Treatment note templates and assignable to an appointment type. Cliniko Help, checked 25 Sep 2026.
- Treatment note templates can be exported by an Administrator as a .json file for another Cliniko account to import, using Chrome rather than Safari for the export. Cliniko Help, checked 25 Sep 2026.
- Cliniko's template import feature accepts JSON, JPG, PNG, WEBP or PDF files up to 5MB, converting unsupported question types to the closest available type. Cliniko Help, checked 25 Sep 2026.