• History Form
• Physical Examination Form
• Clearance Form
• Athletic Participation

Medical History Form

Prior to seeing your physician, you and your child will fill out the History Form. This is a basic pre-appointment form that asks questions about medicines and allergies, heart health, family history, bones and joints, and any potential medical issues.

Specifically, this form helps to give your healthcare provider some basic background information about your student prior to the exam. This is an important time to list any events in one’s health history that could require further review or discussion with a healthcare provider.

Physical Examination Form

Next, the physical examination will include a review of several health indicators, including pulse, lung function, and vision function.

In concluding the exam, the health care provider will:

(1) clear the student for all sports without restriction

(2) clear for sports without restriction, but with recommendations for further evaluation or treatment

(3) not provide immediate clearance.

Clearance Form

Furthermore, upon discharge, the student and parent will be provided with a clearance form that summarizes the exam findings. Subsequently, this form can be used in lieu of the physical exam form and health history form; it may be an appropriate alternative for any circumstances in which HIPAA concerns are an issue.

Consent for Athletic Participation & Medical Care

Finally, the parent or legal guardian of the student athlete will fill out a form detailing allergies, medications, insurance information, and emergency contact information. In addition, this form acknowledges legal responsibilities and protocols in the event of injury.