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Blank Sports Physical Form

The Sports Physical Form is a vital document designed to assess an athlete's health and readiness for participation in sports activities. It collects essential information about the athlete's medical history, family health background, and any potential risks that could affect their performance. Completing this form accurately helps ensure that athletes are fit to compete safely.

Outline

The Sports Physical form serves as a vital tool in ensuring the health and safety of student-athletes. It collects essential information about the athlete, including personal details such as name, gender, and date of birth, alongside contact information for parents or guardians. This form also emphasizes the importance of medical history, prompting both athletes and their families to disclose any relevant health concerns. Questions regarding family medical history, past injuries, and current medications are critical for assessing potential risks. Additionally, the form includes a section for a physician to conduct a thorough physical examination, documenting vital statistics like height, weight, and blood pressure, as well as evaluating various body systems. The physician's assessment culminates in a certification of the athlete's medical readiness to participate in sports, while also allowing for any necessary participation restrictions. By carefully completing this form, families contribute to a safer sporting environment, helping to mitigate risks and promote the well-being of young athletes.

Sample - Sports Physical Form

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: _________________________________________________________________

__________________________________________________________________________________________________

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Form Information

Fact Name	Description
Purpose	The Sports Physical form assesses an athlete's health to determine their fitness for participation in sports.
Medical History Importance	It includes a medical history section that identifies potential health risks related to sports participation.
Parental Involvement	Parents or guardians are required to provide information and consent for the athlete's physical examination.
Physician's Role	A licensed physician, physician's assistant, or family nurse practitioner must complete the physical examination section.
State-Specific Forms	Many states have specific requirements or forms that must be used, governed by local laws regarding youth sports.
Medical Alerts	Athletes must indicate any medical alerts, such as allergies, that could impact their sports participation.
Frequency of Use	The form is typically required annually or prior to the start of each sports season, depending on school or league policies.

Detailed Guide for Filling Out Sports Physical

Filling out the Sports Physical form is an important step in ensuring the health and safety of an athlete before participating in sports. The form collects essential information about the athlete's medical history and current health status, which will be reviewed by a physician during the physical examination.

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 athlete's Date of Birth in the format ___/___/___.
Provide the Father’s Name and his Daytime phone, pager, or cell phone.
Next, fill in the Mother’s Name along with her Daytime phone, pager, or cell phone.
Complete the Street address, City, State, and Zip Code.
Write down the Home phone number.
Provide an Alternate Emergency Contact Person and their Daytime phone.
List any MEDICAL ALERTS such as allergies or conditions like wearing contact lenses.
Carefully answer each question in the Medical History section with YES, NO, or Don’t Know.
If you answered YES to any questions, provide details in the space provided.
Leave the PHYSICAL EXAM section blank for the physician to complete during the examination.
After the examination, ensure the physician fills out their Name, Street Address, City, State, Zip Code, and Telephone.
The physician must sign and date the form, certifying the athlete's medical qualification for sports participation.
If there are any PARTICIPATION RESTRICTIONS, make sure they are clearly noted at the end of the form.

Obtain Answers on Sports Physical

What is the purpose of the Sports Physical form?
The Sports Physical form is designed to assess an athlete's health and fitness level before they participate in sports activities. It helps identify any medical conditions that may pose a risk during physical activity. This form is essential for ensuring the safety of the athlete and is often required by schools and sports organizations.
Who needs to complete the Sports Physical form?
All athletes participating in school sports or organized athletic programs are typically required to complete the Sports Physical form. This includes students of all ages, from youth leagues to high school sports teams.
What information is required on the Sports Physical form?
The form requires personal information such as the athlete's name, gender, date of birth, and contact information for parents or guardians. Additionally, it includes a medical history section where athletes and their families must answer questions about past injuries, illnesses, and any current medical conditions.
What should I do if my child has a medical condition?
If your child has a medical condition, it is crucial to provide detailed information on the Sports Physical form. Be honest and thorough in answering the medical history questions. Consult with a physician to determine if any special considerations or restrictions should be noted on the form.
How often does the Sports Physical need to be completed?
The Sports Physical should be completed annually or as required by the specific sports organization. Some schools may have different timelines, so it is important to check with the athletic department for their specific requirements.
Who can perform the physical examination?
The physical examination must be conducted by a licensed medical physician, physician’s assistant, or family nurse practitioner. It is important to note that a Doctor of Chiropractic Medicine is not an acceptable provider for this examination.
What happens if the athlete is not cleared to participate?
If the athlete is not cleared to participate in sports, the physician will provide participation restrictions on the form. It is essential to follow these restrictions to ensure the athlete's safety and health. Parents should discuss any concerns with the physician and consider follow-up care as needed.
What should I do if my child has allergies?
If your child has allergies, it is important to indicate this on the Sports Physical form. Be specific about the type of allergies, including any medications or environmental factors. This information will help coaches and medical staff respond appropriately in case of an allergic reaction.
Where should I submit the completed Sports Physical form?
The completed Sports Physical form should be submitted to the school’s athletic department or the designated sports organization. Make sure to keep a copy for your records. Check with the specific organization for any additional submission guidelines.

Common mistakes

Filling out the Sports Physical form accurately is essential for ensuring the safety and well-being of young athletes. However, several common mistakes can occur during this process. One significant error is failing to provide complete contact information for parents or guardians. This information is crucial for emergency situations. Incomplete or incorrect phone numbers can delay communication in case of an emergency, potentially putting the athlete at risk.

Another frequent mistake is neglecting to disclose important medical history details. Parents and athletes may overlook past injuries, surgeries, or chronic illnesses that could affect the athlete's participation in sports. For instance, if an athlete has a history of concussions or asthma, this information must be clearly communicated. Omitting such details can lead to inadequate medical assessments and increase the risk of further injury.

Many individuals also misunderstand the importance of the medical alerts section. This part of the form is designed to highlight any allergies or medical conditions that require special attention. Failing to indicate allergies to medications or bee stings can have serious consequences. In the event of an emergency, medical personnel rely on this information to provide appropriate care.

Finally, some parents or athletes may rush through the form and answer questions without fully considering their implications. For example, answering "no" to questions about past injuries or medical conditions without thorough reflection can lead to misrepresentation of the athlete’s health status. This oversight can ultimately result in inadequate preparation for the athlete's safety during sports activities.

Documents used along the form

When preparing for participation in sports, athletes often need to complete various forms in addition to the Sports Physical form. Each document serves a specific purpose to ensure the athlete's health and safety. Here’s a list of commonly required forms and documents:

Consent Form: This document grants permission for the athlete to participate in sports activities. It often includes acknowledgment of risks involved and may require a parent or guardian's signature for minors.
Emergency Contact Form: This form lists individuals to contact in case of an emergency. It typically includes names, phone numbers, and relationships to the athlete.
Health Insurance Information: Athletes may need to provide details about their health insurance coverage. This ensures that any medical expenses incurred during sports activities can be addressed.
Injury Report Form: If an athlete gets injured, this form documents the incident. It includes details about the injury, how it occurred, and any immediate treatment provided.
Waiver of Liability: This document releases the organization from liability in case of injury. Athletes (or their guardians) must understand the risks and agree not to hold the organization responsible.
Code of Conduct Agreement: This agreement outlines expected behavior for athletes during practices and competitions. It emphasizes sportsmanship and respect for coaches, teammates, and opponents.
Medical History Form: Similar to the Sports Physical form, this document collects detailed medical history. It helps healthcare providers understand any pre-existing conditions that may affect the athlete's participation.
Parental Consent for Travel: If athletes travel for competitions, this form gives permission for the athlete to travel with the team. It often includes emergency contact information and medical consent.
Drug Testing Consent Form: In some sports, athletes may be required to consent to drug testing. This form explains the testing process and the athlete's rights regarding the procedure.

Completing these forms accurately and thoroughly is essential for ensuring a safe and successful sports experience. Athletes and their families should take the time to understand each document and its implications. Proper preparation can make a significant difference in an athlete's readiness to participate.

Similar forms

The Sports Physical form is essential for assessing an athlete's health and readiness for sports participation. Several other documents serve similar purposes in different contexts. Here’s a list of eight documents that share similarities with the Sports Physical form:

Health History Questionnaire: This document collects information about a patient's medical history, including previous illnesses and surgeries, similar to the medical history section of the Sports Physical form.
Pre-Participation Physical Evaluation (PPE): Often used by schools and sports organizations, this form assesses an athlete's health and fitness levels before they begin a sport, just like the Sports Physical form.
Emergency Contact Form: This document provides emergency contact information, ensuring that caregivers can be reached in case of an emergency, similar to the contact details requested in the Sports Physical form.
Immunization Record: This form details an individual's vaccinations, which may be required for participation in certain sports, paralleling the health verification aspect of the Sports Physical form.
Consent to Treat Form: This document grants permission for medical treatment in emergencies, akin to the medical authorization implied in the Sports Physical form.
Return-to-Play Form: After an injury, this document confirms that an athlete is cleared to resume sports activities, mirroring the physician's certification in the Sports Physical form.
Medication Administration Record: This document tracks medications administered to students, similar to the section on medications in the Sports Physical form.
Accident Report Form: Used to document injuries or accidents that occur during sports activities, this form complements the injury history inquiries found in the Sports Physical form.

Dos and Don'ts

When filling out the Sports Physical form, it's important to be thorough and accurate. Here are some guidelines to help you navigate the process.

Do read each question carefully. Make sure you understand what is being asked before answering.
Do provide complete and honest answers. This information is vital for your safety and health during sports activities.
Do include all relevant medical history. If there are any past injuries or conditions, be sure to mention them.
Do ensure that contact information is accurate. This includes phone numbers for parents and emergency contacts.
Don't rush through the form. Take your time to avoid mistakes or omissions that could affect your eligibility.
Don't ignore the medical alert section. If there are allergies or other important health details, they must be noted.

By following these guidelines, you can help ensure that the Sports Physical form is filled out correctly, providing essential information for your health and safety.

Misconceptions

Misconception 1: The Sports Physical form is only necessary for high school athletes.

In reality, athletes of all ages, including middle school students and those participating in recreational sports, may be required to complete this form.

Misconception 2: A Sports Physical is just a routine check-up.

This form serves a specific purpose: to assess an athlete's health and readiness for sports participation, focusing on injury risk and overall fitness.

Misconception 3: Parents can fill out the medical history section without consulting a physician.

While parents can provide information, it is essential to discuss any concerns with a physician during the physical examination.

Misconception 4: Only physical injuries are considered in the medical history.

Medical history includes a range of issues, such as chronic illnesses, allergies, and mental health concerns, which can impact athletic performance.

Misconception 5: The Sports Physical form is the same for all sports.

Different sports may have specific requirements or considerations, and the form may vary accordingly.

Misconception 6: Once completed, the Sports Physical form does not need to be updated.

It is important to update the form annually or whenever there are significant changes in the athlete's health status.

Misconception 7: A Sports Physical is only about passing or failing.

The goal is to identify any health issues and ensure that the athlete is fit to compete, not just to determine eligibility.

Misconception 8: The form guarantees that an athlete will not get injured.

No form can predict injuries. However, it helps identify risks and promotes safer participation in sports.

Misconception 9: A physician's signature on the form is not important.

The signature indicates that a qualified medical professional has assessed the athlete, which is crucial for ensuring safety.

Misconception 10: Athletes do not need to disclose all medical conditions.

Full disclosure is vital. Undisclosed conditions can lead to serious health risks during sports participation.

Key takeaways

Complete all sections: Ensure that every section of the Sports Physical form is filled out completely. Missing information can delay the approval process.
Provide accurate medical history: Athletes and parents should answer all medical history questions truthfully. This information is vital for assessing health risks.
Include emergency contacts: List reliable emergency contacts, including their phone numbers. This is crucial in case of an emergency during sports activities.
Discuss medical alerts: Clearly indicate any medical alerts, such as allergies or chronic conditions. This information helps coaches and medical staff respond appropriately.
Schedule a timely physical exam: Arrange for the physical examination with a licensed medical professional well before the sports season begins. This ensures that any issues can be addressed early.
Review family medical history: Be aware of any family history of sudden death or health issues that may affect the athlete's health and safety.
Understand the importance of the exam: The physical exam assesses the athlete's fitness for participation in sports and identifies any potential health risks.
Document any restrictions: If the physician identifies any participation restrictions, they should be documented clearly on the form.
Keep a copy of the form: Retain a copy of the completed Sports Physical form for your records. This can be useful for future reference or if questions arise.
Communicate concerns: If the athlete has any current health concerns, discuss them with the physician during the examination. Open communication is key to ensuring safety.