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Fill in a Valid Sports Physical Form

The Sports Physical Form is a 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 current physical condition. Completing this form is a crucial step in ensuring the safety and well-being of young athletes.

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➤ PDF File

Example - 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: _________________________________________________________________

__________________________________________________________________________________________________

Documents used along the form

When preparing for sports participation, the Sports Physical form is often accompanied by various other documents. Each of these forms serves a specific purpose and helps ensure that the athlete is fully prepared and safe to engage in sports activities. Below is a list of common forms that may be required alongside the Sports Physical form.

Consent to Treat Form: This document gives permission for medical professionals to provide treatment to the athlete in case of injury or emergency. It typically includes information about the athlete’s medical history and emergency contacts.
Emergency Contact Form: This form lists individuals who can be contacted in case of an emergency. It includes names and phone numbers of parents or guardians, as well as any other designated contacts.
Hold Harmless Agreement: When engaging in potentially risky activities, it's important to have the comprehensive Hold Harmless Agreement considerations to protect parties from liability issues.
Medical History Form: This form collects detailed information about the athlete's past medical conditions, surgeries, and allergies. It helps healthcare providers understand any risks associated with the athlete's health.
Assumption of Risk Form: This document outlines the potential risks associated with participating in sports. Athletes or their guardians must sign this form to acknowledge their understanding of these risks.
Release of Liability Form: By signing this form, the athlete or their guardian agrees not to hold the organization responsible for any injuries sustained during participation. It is a way to protect the organization legally.
Health Insurance Information Form: This form collects details about the athlete's health insurance coverage. It ensures that medical expenses can be covered in case of an injury.
Behavioral Contract: This document outlines the expectations for the athlete’s behavior during practices and games. It may include guidelines on sportsmanship and conduct.
Participation Agreement: This form requires the athlete and their guardians to agree to the rules and regulations of the sports program. It often includes commitments to attend practices and games regularly.

Each of these forms plays a vital role in ensuring that athletes are safe, informed, and prepared for their sports activities. Having the necessary paperwork in order can help streamline the process and provide peace of mind for both athletes and their families.