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The Sports Physical Form is a crucial document designed to assess an athlete's health before participation in sports activities. It collects essential information about the athlete's medical history, current health status, and any potential risks. Completing this form accurately helps ensure the safety and well-being of the athlete during sports events.

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Content Overview

The Sports Physical form is an essential document designed to ensure the safety and well-being of young athletes participating in sports activities. It collects vital information about the athlete, including their name, gender, date of birth, and emergency contact details for parents or guardians. This form requires a comprehensive medical history, prompting both athletes and their families to disclose any relevant health issues, such as previous injuries, chronic illnesses, or allergies. Specific questions address serious concerns, including a family history of sudden death, experiences of dizziness during exercise, and any history of concussions or heat-related illnesses. Following the medical history section, a licensed physician conducts a physical examination, assessing various health aspects such as height, weight, blood pressure, and vision. The physician also evaluates the athlete's cardiovascular health, musculoskeletal system, and other critical areas to determine their fitness for sports participation. Finally, the form includes a section for the physician to note any participation restrictions, ensuring that athletes engage in sports safely and responsibly.

Key takeaways

Filling out and using the Sports Physical form is essential for ensuring the safety and well-being of young athletes. Here are key takeaways to consider:

The form must be completed accurately and thoroughly to provide a clear medical history.
Parents and guardians should review all questions with the athlete before the physical examination.
It is crucial to disclose any medical alerts, such as allergies or chronic conditions, in the designated section.
Answer all medical history questions honestly, as they help assess the athlete's risk of injury.
Be aware of any family history of sudden deaths or medical conditions that could affect the athlete.
The physical exam section must be completed by a licensed medical professional, such as a physician or nurse practitioner.
Ensure that the physician provides their contact information and signature to validate the examination.
Participation restrictions, if any, should be clearly noted by the physician to guide the athlete’s involvement in sports.
Keep a copy of the completed form for personal records and to provide to the school or sports organization.
Timely submission of the form is critical to ensure that the athlete can participate in upcoming sports activities.

Guide to Writing Sports Physical

Completing the Sports Physical form is an important step in ensuring that an athlete is ready to participate in sports activities. This form collects essential health information that will be reviewed by a physician during the physical examination. Following these steps will help ensure that the form is filled out correctly.

Begin by writing the athlete's Name at the top of the form.
Indicate the athlete's Gender by marking either "M" or "F."
Fill in the Date of Birth in the format ___/___/___.
Provide the Father’s Name and his Daytime phone, pager, or cell phone number.
Provide the Mother’s Name and her Daytime phone, pager, or cell phone number.
Complete the Street address, City, State, and Zip Code.
Enter the Home phone number.
List an Alternate Emergency Contact Person and their Daytime phone number.
Indicate any MEDICAL ALERTS such as allergies or special conditions.
Answer the Medical History questions honestly, marking "YES," "NO," or "Don’t Know" for each question.
Provide details for any "YES" answers in the space provided.
Leave the PHYSICAL EXAM section blank for the physician to complete during the examination.
After the examination, the physician will fill in the Height, Weight, Pulse, Blood Pressure, and Vision details.
The physician will check the Normal/Abnormal Findings for various health categories.
Ensure the physician signs and dates the form, confirming the examination.
Note any PARTICIPATION RESTRICTIONS as indicated by the physician.

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Sports Physical Form

Name: ______________________________________ Gender: M F Date of Birth: ___/___/___

Father’s Name: _________________________ Daytime phone, pager, cell phone: _______________________

Mother’s Name: ________________________ Daytime, phone, pager, cell phone: _______________________

Street address: _____________________________________________________________________________

City: _________________ State: _______ Zip Code: __________ Home phone: ________________________

Alternate Emergency Contact Person: ______________________ Daytime phone: _______________________

Please indicate MEDICAL ALERTS such as allergic reactions, contact lenses, etc.: ______________________

__________________________________________________________________________________________

Medical History:

Athletes and parents: This health record is a critical element in the determination of an athlete’s risk of injury in sports. Please take the time to read and answer all questions before seeing a physician for the athlete’s physical examination.

1.	Has anyone in the athlete’s family (grandparents, mother, father, brother, sister, aunt,	YES	NO	Don’t Know
	uncle) died suddenly before age 50?
2.	Has the athlete ever stopped exercising because of dizziness or passed out during exercise?	YES	NO	Don’t Know
3.	Does the athlete have asthma (wheezing), hay fever, or coughing spells after exercise?	YES	NO	Don’t Know
4.	Has the athlete ever had a broken bone, had to wear a cast, or had an injury to any joint?	YES	NO	Don’t Know
5.	Does the athlete have a history of concussion (getting knocked out)?	YES	NO	Don’t Know
6.	Has the athlete ever suffered a heat-related illness (heat stroke)?	YES	NO	Don’t Know
7.	Does the athlete have a chronic illness or see a doctor regularly for any particular problem?	YES	NO	Don’t Know
8.	Does the athlete take any medication(s)?	YES	NO	Don’t Know
9.	Is the athlete allergic to any medications or bee stings?	YES	NO	Don’t Know
10.	Does the athlete have only one of any paired organs? (Eyes, ears, kidneys, testicles, ovaries)	YES	NO	Don’t Know
11.	Has the athlete had an injury in the last year that caused the athlete to miss 3 or more	YES	NO	Don’t Know
	consecutive days of practice or competition?	YES	NO	Don’t Know
12. Has the athlete had surgery or been hospitalized in the past year?		YES	NO	Don’t Know
13. Has the athlete missed more than 5 consecutive days of participation in usual activities		YES	NO	Don’t Know
	because of illness, or has the athlete had a medical illness diagnosed that has not been
	resolved in the past year?
14.	Are you, the athlete, worried about any problem or condition at this time?	YES	NO	Don’t Know

Please give details on any “YES” answer from the above health history.

____________________________________________________________________________________________________________

__________________________________________________________________________________________

PHYSICAL EXAM – TO BE COMPLETED BY PHYSICIAN

Height __________	Weight __________	Pulse __________	Blood Pressure __________
Vision: R _____ / _____ uncorrected R _____ / _____ corrected			L _____ / _____ uncorrected L _____ / _____ corrected

Normal

Abnormal Findings

1.Eyes

2.Ears, Nose, Throat

3.Mouth & Teeth

4.Neck

5.Cardiovascular

6.Chest & Lungs

7.Abdomen

8.Skin

9.Genitalia-Hernia (male)

10.Muskuloskeletal: ROM, strength, etc.

a.neck

b.spine

c.shoulders

d.arms/ hands

e.hips

f.thighs

g.knees

h.ankles

i.feet

11.Neuromuscular

Initials

Please Print/ Stamp

Physician’s Name ___________________________________________________________________________________

Street Address _____________________________________________________________________________________

City, State, Zip Code ________________________________________________________________________________

Telephone _________________________________________________________________________________________

I certify that I have examined this athlete and found him/her medically qualified to participate in sports. I also certify that I am a licensed medical physician, physician’s assistant, or family nurse practitioner. (Doctor of Chiropractic Medicine is not satisfactory.)

Physician Signature __________________________________________________________ Date __________________

PARTICIPATION RESTRICTIONS: _________________________________________________________________

__________________________________________________________________________________________________

Documents used along the form

The Sports Physical form is essential for ensuring that young athletes are medically fit to participate in sports. However, several other documents often accompany it to provide a comprehensive view of the athlete's health, parental consent, and emergency contact information. Below is a list of these documents, each serving a specific purpose.

Parental Consent Form: This document grants permission for a minor to participate in sports activities. It typically includes acknowledgment of risks and waivers of liability.
Emergency Contact Form: This form lists individuals who can be contacted in case of an emergency. It includes names, phone numbers, and relationships to the athlete.
Health History Form: This document collects detailed medical history from the athlete. It addresses previous injuries, surgeries, and any ongoing health issues.
Employment Verification Form: This document is essential for confirming the employment history of athletes, particularly when they engage in professional sports or need to fulfill sponsorship obligations. For more information, visit OnlineLawDocs.com.
Insurance Information Form: This form captures the athlete's health insurance details. It is crucial for covering medical expenses in case of injury during sports activities.
Immunization Record: This document provides proof of vaccinations. Many sports programs require up-to-date immunizations to protect the health of all participants.
Concussion Awareness Form: This form educates athletes and parents about the signs and risks of concussions. It often requires signatures to acknowledge understanding.
Waiver of Liability: This legal document releases the sports organization from responsibility for injuries that may occur during participation. Athletes and parents typically sign it before the season starts.
Code of Conduct Agreement: This document outlines expected behavior for athletes during practices and competitions. It often includes consequences for violations.

These documents work together to ensure the safety and well-being of young athletes. By providing necessary information and permissions, they help facilitate a smooth and responsible sports experience.