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Sports Physical Template

The Sports Physical Form is a comprehensive document designed to gather essential health information from athletes before they participate in any sports activities. It includes sections for personal details, medical history, and a physical examination by a healthcare professional, ensuring that the athlete is medically fit to engage in sports. For a safe and informed sports season, make sure to fill out this form thoroughly by clicking the button below.

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Table of Contents

Before young athletes can leap into their next season, they often require a green light in the form of a Sports Physical. This document isn't just a formality; it's a vital health check to ensure the safety and readiness of participants for the rigors of sports. The form captures essential personal details, including the athlete's name, gender, birth date, and parental contact information, ensuring responsible parties are reachable. Crucially, it includes a section for medical alerts that could impact the athlete's participation, such as allergic reactions or the need for contact lenses. The comprehensive medical history section asks probing questions about the athlete's past medical events, family health history, medication, allergies, and any history of surgical interventions. These inquiries aim to uncover any underlying conditions that might elevate the risk of injury or complications during physical activity. Furthermore, the form mandates a physical examination by a qualified medical professional who assesses various health aspects from cardiovascular health to musculoskeletal integrity. Only after a thorough evaluation can the healthcare provider sign off, declaring the athlete medically fit for sports participation, or specify any restrictions that should be observed. This rigorous process underscores the importance of prioritizing health and safety in youth sports, ensuring every athlete is physically and medically prepared to take on the challenges of competitive play.

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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: _________________________________________________________________

__________________________________________________________________________________________________

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Form Breakdown

Fact	Detail
Personal Information	Includes athlete's name, gender, date of birth, and parents' or guardians' names and contact information.
Address Details	Captures the street address, city, state, and zip code where the athlete resides, along with home and alternate emergency contact numbers.
Medical Alerts	Section for indicating any immediate medical alerts like allergies or conditions such as asthma.
Medical History	Questions focused on family medical history, past injuries or illnesses, and current health status to assess risk.
Medication and Allergies	Asks whether the athlete is on medication or has allergies, specifically to medication or bee stings.
Physical Examination	Must be completed by a physician, detailing the athlete's height, weight, pulse, blood pressure, and vision.
Examination Findings	Includes observations on eyes, ears, nose, throat, cardiovascular system, and more, with space for the physician to note normal or abnormal findings.
Physician Certification	Confirmation by a physician, physician’s assistant, or family nurse practitioner (excluding Doctors of Chiropractic Medicine) of the athlete's fitness for sports participation.
Participation Restrictions	Space for the physician to note any restrictions on the athlete's participation in sports activities.

Guidelines on Filling in Sports Physical

Before engaging in any sports activities, filling out a Sports Physical Form is a crucial step. This document records vital medical information that can significantly influence an athlete's ability to safely participate in sports. It ensures that the health risks associated with sports activities are minimized. To complete this form accurately, attention to detail and thoroughness are key. Each section must be filled out fully, providing clear and up-to-date medical information. Here's how to approach filling out the form:

Start by entering the athlete's Name at the top of the form.
Select the athlete's Gender by checking the appropriate box (M or F).
Fill in the Date of Birth with the format MM/DD/YYYY.
Enter the Father’s Name and provide a contact number that includes daytime phone, pager, or cell phone.
Similarly, provide the Mother’s Name and her contact number (daytime phone, pager, or cell phone).
Write down the Street address, City, State, and Zip Code where the athlete resides.
Include a Home phone number for general inquiries or additional contact.
Identify an Alternate Emergency Contact Person and provide their daytime phone number.
In the section labeled MEDICAL ALERTS, list any critical medical information such as allergic reactions, the use of contact lenses, etc.
Under Medical History, carefully read each statement. For each question, mark the response that applies: YES, NO, or Don’t Know. It's essential to be honest and complete in these answers.
Provide details for any question you answered "YES" to in the Medical History section, explaining the condition or situation.
Leave the PHYSICAL EXAM section blank; this portion will be completed by a licensed medical professional after evaluating the athlete.
The physician will fill out the findings from the physical exam, including Height, Weight, Pulse, and Blood Pressure.
The vision test results will be recorded in the specified boxes for both the right and left eyes, with notations for uncorrected and corrected vision.
Normal and abnormal findings across various health categories such as eyes, ears, nose, throat, cardiovascular health, and more, will be noted by the physician.
Finally, the physician will complete the form with their Initials, Printed/Stamped Name, Address, City, State, Zip Code, and Telephone number. They will certify the athlete’s medical clearance to participate in sports by signing and dating the form.
If there are any PARTICIPATION RESTRICTIONS, the physician will note them at the end of the document.

Filling out the Sports Physical Form is a straightforward process that plays a pivotal role in safeguarding athletes' health and well-being. By providing comprehensive and accurate information, parents and athletes contribute essential details that help medical professionals assess and manage health risks in sports participation.

Learn More on Sports Physical

What is the purpose of a Sports Physical Form?

The Sports Physical Form serves as a thorough health assessment to ensure an athlete is physically and medically fit to participate in sports activities. This form collects vital health information, including medical history, allergies, medication use, and family health history, to identify any conditions that might increase the athlete's risk of injury during sports participation. Completing this form and undergoing a physical examination are critical steps in promoting safe sports participation and minimizing the risk of sports-related injuries.

Who needs to complete the Sports Physical Form?

Any athlete who plans to participate in sports activities, whether at school, college, or community sports programs, needs to complete the Sports Physical Form. This form is typically required before the athlete can begin practicing or competing in any sports event. It is crucial for assessing the athlete's health status and identifying any conditions that might require special attention or restrict their participation in sports.

What information is required on the Sports Physical Form?

The form requires detailed information regarding the athlete's personal and medical history. This includes:

Basic personal information such as name, gender, date of birth, and contact details.
A detailed medical history that includes questions about previous illnesses, surgeries, hospitalizations, medication use, allergies, and family health history.
A section for medical alerts that could be crucial in case of an emergency (e.g., allergic reactions, contact lenses).
The physical examination section to be completed by a physician, which covers various health aspects such as height, weight, vision, cardiovascular health, musculoskeletal condition, and more.

Additionally, the form has a section for the physician to note any participation restrictions based on their findings.

Can the Sports Physical Form be filled out by any doctor?

The physical examination section of the form must be completed by a licensed medical physician, physician's assistant, or family nurse practitioner. It specifically notes that a Doctor of Chiropractic Medicine does not meet the requirements for conducting the sports physical examination. This ensures that the athlete undergoes a comprehensive health evaluation by a professional with the appropriate medical background and credentials to assess the athlete’s readiness for sports participation adequately.

How often does the Sports Physical Form need to be updated?

Most organizations require that the Sports Physical Form be completed annually. However, the exact frequency can vary depending on state laws and the policies of the sports organization or educational institution. This yearly examination helps monitor any changes in the athlete's health status and ensures ongoing eligibility and safety in sports participation. It's important for athletes and parents to stay informed about the specific requirements of their sports program regarding the validity of the sports physical.

Common mistakes

When it comes to filling out Sports Physical forms, accuracy and thoroughness are essential. However, people often make mistakes during this process, potentially affecting the athlete's ability to participate. Here are nine common mistakes:

Not providing complete contact information: It is crucial to fill in all contact details, including daytime and home phone numbers, for both parents or guardians. This ensures the school or sports organization can reach the family in case of emergencies.
Leaving medical alerts blank or incomplete: If an athlete has any medical conditions like allergies or requires the use of contact lenses, it’s important to note these clearly. This information is vital for first responders in case of an emergency.
Skipping details in the medical history section: Each question in the medical history must be addressed. Not only does this include past injuries or chronic illnesses, but also details about any family history of sudden illnesses or conditions that might influence the athlete's health.
Forgetting to update medication information: It’s easy to overlook changes in medication, but it's essential to report any current medications the athlete is taking, including over-the-counter drugs.
Omitting details on past injuries or surgeries: Even if an athlete believes a past injury or surgery is no longer relevant, it should still be mentioned. This history could impact their current fitness for participation in sports.
Not clearly indicating participation restrictions: If there are any restrictions on what the athlete can or cannot do, these should be clearly detailed by the examining physician in the designated section. This ensures proper accommodations can be made.
Failing to detail "YES" answers: Just ticking 'YES' to any of the health history questions without providing further information can leave those reviewing the form with insufficient insight into the athlete's health status.
Overlooking the physician’s credentials: The form specifies that it must be completed by a licensed medical physician, physician’s assistant, or family nurse practitioner. A doctor of chiropractic medicine, for instance, is not acceptable. This detail is often missed.
Leaving the participation restrictions section vague: If the athlete does have restrictions, it's important that these are outlined specifically, so there's no confusion about what the athlete can safely do.

By paying careful attention to these common pitfalls, parents, guardians, and athletes can ensure that the Sports Physical form is filled out correctly and thoroughly, supporting a smooth and safe participation in sports activities.

Documents used along the form

Completing a sports physical form, especially for young athletes or student-athletes, often necessitates the inclusion of additional forms and documents to fully meet the administrative requirements and health safety standards set forth by schools or sports organizations. These documents play a crucial role in ensuring the athlete's readiness and safety for participation in athletic activities. Below is a summary of these key forms and documents often accompanying the Sports Physical Form.

Medical History Form: This document provides a detailed account of the athlete's medical history, including past illnesses, surgeries, hospitalizations, allergies, and any ongoing medical conditions. It helps healthcare providers understand the athlete's health background, aiding in the evaluation of their fitness for sports participation.
Immunization Record: Schools and sports organizations often require an up-to-date immunization record to ensure the athlete is protected against common infectious diseases, aligning with public health recommendations and reducing disease outbreak risks within the team or organization.
Consent and Release Form: This legal document is signed by the athlete and, if the athlete is a minor, their parent or guardian. It grants permission for the athlete to participate in sports and often includes a release of liability clause for the organization, acknowledging the risks involved in sports participation.
Emergency Medical Authorization Form: In case of a medical emergency during practice or competition, this form authorizes team coaches, school personnel, or medical staff to make healthcare decisions on behalf of the athlete, if the parent or guardian cannot be reached. It provides essential contact information, insurance details, and preferred hospitals or medical facilities.

These additional documents are vital for completing the sports participation clearance process, ensuring the athlete's health is adequately reviewed and managed, and legal and emergency preparedness measures are in place. While the sports physical form focuses on the athlete's current physical health status, these accompanying forms provide a comprehensive view of the athlete's medical history, legal permissions, and emergency care preferences, contributing to a safer sports participation environment.

Similar forms

The Sports Physical Form shares similarities with Annual Physical Examination Forms used in general healthcare. Both documents are vital in assessing an individual's overall health status, emphasizing the detection of possible health conditions that might impair someone's ability to engage in specific activities safely. They require a thorough history-taking section about past medical events, family history of diseases, allergies, and the individual's medication use. Additionally, both forms include a comprehensive physical examination checklist that covers various body systems to ensure the person is in optimal health for their activities or general well-being.
It is also akin to Pre-employment Physical Examination Forms. Employers often require these examinations to determine if an applicant is physically capable of performing the duties associated with a job offer. Like the Sports Physical Form, these documents entail a detailed medical history, inquire about past illnesses or surgeries, and assess physical capabilities. Both aim to identify any physical limitations that might affect performance on the field or in the workplace, focusing on ensuring individuals are fit for the tasks ahead.
Another related document is the Driver’s Physical Examination Form. Individuals applying for a commercial driver's license must undergo this examination to ensure they meet the physical requirements necessary for safe driving. Similar to the Sports Physical Form, the driver’s examination includes sections on medical history, vision and hearing assessment, and a physical examination that assesses musculoskeletal integrity and cardiovascular health. Both forms serve the purpose of identifying conditions that could compromise safety, whether on the road or the sports field.
Lastly, the Sports Physical Form resembles School Entrance Health Forms. Before starting a new school year, students are often required to submit these forms, which document their immunization records, past medical history, and a recent physical examination. Like the sports form, they are designed to protect the individual and those around them by ensuring they are free from health conditions that could affect their participation in school activities. Both documents include a thorough medical inventory and an assessment by a qualified healthcare provider, confirming the individual's suitability for attending school or playing sports.

Dos and Don'ts

Filling out a Sports Physical form is a critical step in ensuring the safety and health of athletes. Here are 7 dos and don'ts to guide you through the process:

Do:

Read through the entire form before starting to fill it out. This ensures you understand what information is required.
Answer all questions honestly. Your responses help in assessing the athlete's readiness for sports activities.
Provide detailed information on medical history. If a question is answered with 'Yes', give specifics to help the physician understand the athlete's condition.
Update the form with any new medical information. If the athlete's health status changes, make sure this is reflected in their records.
Include information about any medications the athlete is taking. This includes over-the-counter and prescription drugs.
Check all contact information for accuracy. Emergency contacts should be up to date.
Ensure the form is signed by a qualified physician. Acceptable certifications include a medical doctor, physician's assistant, or family nurse practitioner.

Don't:

Leave sections blank. If a question does not apply, write 'N/A' to indicate this to the examiner.
Guess on medical history questions. If unsure, it's better to check 'Don't Know' rather than provide inaccurate information.
Overlook the details in the 'Medical Alerts' section. Specific allergies or conditions like asthma should be clearly indicated.
Rush through filling out the form. Taking your time can ensure all information is accurate and complete.
Let the athlete fill the form out alone. Parents or guardians should be involved in the process to ensure accuracy.
Forget to provide an alternate emergency contact. Having an extra contact can be crucial in an emergency situation.
Ignore the physician's participation restrictions. These are put in place for the athlete's safety and must be adhered to.

Misconceptions

Misconceptions About the Sports Physical Form

Sports physical forms are essential in assessing an athlete's health and readiness to participate in sports. However, some misunderstandings persist about these forms and their requirements. It's important to clear up these misconceptions to ensure athletes, parents, and guardians are fully informed.

Sports physicals are the same as regular physical exams. While both types of physicals evaluate the athlete's general health, a sports physical focuses more on the athlete's ability to participate in sports. This includes evaluating the athlete's risk of injury and specific fitness levels related to athletic performance.
One physical exam is enough for any sport. Different sports may impose different demands on an athlete's body, and what is deemed safe for one sport might not be safe for another. It's crucial to discuss with the healthcare provider the specific sport the athlete is considering to accurately assess risk factors and qualifications.
Only high school athletes need a sports physical. Younger children also benefit from sports physicals. These exams can identify health issues that may impede participation or require treatment to ensure safe play at any age and competition level.
If an athlete feels fine, they don't need a sports physical. Some health issues that could be a risk to athletes might not show immediate symptoms. Conditions like unrecognized heart defects or asthma can be life-threatening under physical stress. A sports physical aims to identify these hidden risks.
Information on a sports physical form is only relevant for the upcoming sports season. The medical history and examination findings provide valuable health information beyond the sports context. They can detect early signs of health problems that can be addressed proactively, providing benefits well into the future.

Understanding these aspects of the sports physical form can enhance the safety and health of young athletes, encouraging a supportive environment for their physical activities. It's always best to approach sports physicals with thoroughness and care, ensuring any potential health issues are identified and managed appropriately before participation.

Key takeaways

The Sports Physical Form is a vital document designed to assess an athlete's eligibility and safety for participation in sports. Here are nine key takeaways to ensure its effectiveness and compliance:

Completion of the form requires accurate and current medical information, underscoring the importance of details such as the athlete's name, gender, date of birth, and comprehensive contact information for both parents or guardians.
It is essential to clearly note any medical alerts that could impact the athlete’s performance or require immediate attention, including allergies, use of contact lenses, or other pertinent medical concerns.
The medical history section plays a critical role in identifying potential risk factors for injuries or complications during sports activities. It requires honest and thorough responses from both athletes and their parents.
Questions about family medical history, past incidents of dizziness or fainting during exercise, and any history of concussions or heat-related illnesses are designed to uncover any underlying conditions that may not be obvious but could pose significant risks.
Providing information on any chronic illnesses, regular medications, and allergies, including to medications or bee stings, is crucial for preparing for any potential emergency situations during sports participation.
The section on recent injuries, surgeries, or hospitalizations gives healthcare providers insight into the athlete’s recent physical health and any potentially unresolved issues that could be aggravated by intensive physical activity.
Details on any part of the health history that may affect sports participation must be supplemented with specific information on “YES” responses, enabling healthcare providers to fully understand the scope and implications of each issue.
The physical exam should be conducted by a certified medical professional—such as a physician, physician's assistant, or family nurse practitioner—excluding Doctors of Chiropractic Medicine, to ensure the assessment meets the standards required for sports participation.
Finally, any participation restrictions, whether temporary or permanent, must be clearly stated by the examining healthcare provider, outlining restrictions or necessary accommodations to safeguard the athlete’s health during sporting activities.

This document not only facilitates a safer sporting environment but also ensures that athletes are medically cleared and physically prepared for the demands of their sports, ultimately contributing to the prevention of sports-related injuries and health complications.

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