Sports Medicine Pre-Participation Exam Form

Sports Medicine Pre-Participation Exam Form — Form Fields

This healthcare template includes 13 fields. Student athletes complete a pre-participation physical exam form for clearance to play sports. Free to customize and use on ZenBuild.

• Athlete Full Name (text, required)
• Date of Birth (text, required)
• School and Grade (text, required)
• Sport(s) to Participate In (text, required)
• History of Concussion? (dropdown selection, required) — options: Yes, No
• History of Fracture? (dropdown selection, required) — options: Yes, No
• History of Heart Condition? (dropdown selection, required) — options: Yes, No
• History of Heat-Related Illness? (dropdown selection, required) — options: Yes, No
• Currently Taking Any Medications? (dropdown selection, required) — options: Yes, No
• Medications Listed (text, optional)
• Allergies to Medications? (dropdown selection, required) — options: Yes, No
• Physician Clearance Status (dropdown selection, required) — options: Cleared - No Restrictions, Cleared - With Restrictions, Not Cleared, Pending Results
• Restrictions or Notes from Physician (long text, optional)