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Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. HE0503 9-2681/0410
PHYSICAL EXAMINATION FORM Name _____ Date of birth _____ PHYSICIAN REMINDERS 1. Consider additional questions on more sensitive issues • Do you feel stressed out or under a lot of pressure? • Do you ever feel sad, hopeless, depressed, or anxious?
Doctors and school nurses can use this free, printable athletic physical form to evaluate athletes and students involved in sports. Easy to download and print.
As a minimum requirement, this Physical Examination Form must be completed prior to junior high participation and again prior to first and third years of high school participation. It must be completed if there are yes answers to specific questions on the student's MEDICAL HISTORY FORM on the reverse side.
As a prerequisite to participation in IHSA athletic activities, we agree that I/our student will not use performance-enhancing substances as defined in the IHSA Performance-Enhancing Substance Testing Program Protocol.
I have examined the student named on this form and completed the preparticipation physical evaluation. The athlete does not have apparent clinical contraindications to practice and can participate in the sport(s) as outlined on this form.
A Sports Physical Form, also known as a preparticipation physical evaluation, is an important document that athletes need to have and complete before participating in a sporting event. Schools, little leagues, and sports organizations that manage sporting events normally require them.
Name of Physician (Print / Type): Date: Address: Phone: Signature of physician: MD/DO pre-participation evaluation - Sports Care v1.odt. Title: Generic_Sports_Physical_Form.pdf Created Date: 2/18/2016 5:18:34 PM ... Generic_Sports_Physical_Form.pdf Created Date: 2/18/2016 5:18:34 PM ...
The athlete does not have apparent clinical contraindications to practice and can participate in the sport(s) as outlined on this form. A copy of the physical examination findings are on record in my office and can be made available to the school at the request of the parents.
pre-participation physical examination. The athlete may/may not participate in the sport(s) outlined on the Recommendations for Participation in Physical Education and Sports form.