Sports Physical Form PDF Details

A sports physical form is a document that is filled out by a doctor and signed by a parent or guardian to ensure that a child is physically able to participate in sports. The form covers everything from the child's medical history to their current condition. Most schools and athletic leagues require a sports physical before allowing a student to participate in any sport.

Below, you'll see quite a few details about sports physical form PDF. You may browse it before typing in the form.

QuestionAnswer
Form NameSports Physical Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessports physical paper online, sports physical paper, physi form, physical paper for sports

Form Preview Example

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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