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Fill Out a Valid Sports Physical Template

The Sports Physical Form is a crucial document that ensures young athletes are medically cleared to participate in sports activities. This form collects essential information about the athlete's medical history, family health background, and any existing conditions that could affect their performance or safety. Completing this form accurately is vital for the well-being of the athlete, so please take a moment to fill it out by clicking the button below.

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Fill Out a Valid Sports Physical Template

Content Overview

Guide to Writing Sports Physical

Filling out the Sports Physical form is an important step in ensuring that an athlete is ready for participation in sports activities. This form collects essential information about the athlete's health history and current medical status. To complete it accurately, follow the steps outlined below.

Begin with the athlete's personal information: Write the athlete's name, gender, and date of birth at the top of the form.
Fill in parent or guardian details: Include the names and daytime contact numbers for both the father and mother.
Provide the athlete's address: Write the street address, city, state, and zip code.
List an alternate emergency contact: Write the name and daytime phone number of an alternate contact person.
Indicate any medical alerts: Note any allergies or specific medical conditions that the athlete has.
Complete the medical history section: Answer each question regarding the athlete’s health history by marking 'YES,' 'NO,' or 'Don’t Know.' Be thorough and honest.
Provide details for any 'YES' answers: If applicable, explain any 'YES' responses in the space provided.
Leave the physical exam section for the physician: This section must be completed by a licensed medical professional during the physical examination.
Physician's information: After the examination, the physician will fill in their name, address, and contact information.
Signature and date: The physician will sign and date the form, certifying that the athlete is medically qualified to participate in sports.
Participation restrictions: If there are any restrictions, the physician will note them in the designated area.

Document Breakdown

Fact Name	Description
Purpose	The Sports Physical Form is designed to assess an athlete's health and fitness level to ensure they are safe to participate in sports activities.
Medical History	The form includes questions about the athlete's medical history, including family health issues and any past injuries.
Emergency Contacts	It requires the names and contact information for parents and an alternate emergency contact person.
Medical Alerts	Parents and athletes must indicate any medical alerts, such as allergies or chronic conditions, to inform healthcare providers.
Physical Examination	A licensed medical professional must complete the physical examination section, confirming the athlete's fitness for sports.
State-Specific Forms	Some states may have specific requirements or additional forms that must be completed in accordance with local laws.
Validity Period	Typically, a sports physical is valid for one year, after which a new examination is required.
Parental Consent	Parents or guardians must sign the form, indicating their consent for the athlete to participate in sports.
Confidentiality	The information provided on the Sports Physical Form is confidential and should only be shared with authorized personnel.

FAQ

What is the purpose of the Sports Physical form?

The Sports Physical form is designed to assess an athlete's health and readiness for participation in sports. It collects important information about the athlete's medical history, current health status, and any potential risks. This form helps ensure that athletes are physically fit to compete and can help identify any health concerns that may need attention before they participate in sports activities.

Who needs to fill out the Sports Physical form?

All athletes participating in school sports or organized athletic programs typically need to complete the Sports Physical form. This includes students of all ages, from elementary through high school. Parents or guardians should assist younger athletes in filling out the form to ensure that all medical history and contact information is accurate and complete.

What kind of medical history information is required?

The form requires detailed medical history information, including:

Family history of sudden death before age 50.
Personal history of fainting, dizziness, or stopping exercise due to health issues.
Any chronic illnesses or ongoing treatments.
Allergies to medications or other substances.
Past injuries, surgeries, or hospitalizations.

Providing complete and accurate information is crucial for the safety and health of the athlete.

What happens during the physical examination?

During the physical examination, a licensed medical professional will evaluate the athlete's overall health. This includes measuring height, weight, pulse, and blood pressure. The physician will also check various body systems such as eyes, ears, heart, lungs, and musculoskeletal health. The doctor will document any findings and determine if the athlete is medically qualified to participate in sports.

What should I do if the athlete has a medical condition?

If the athlete has a medical condition, it is essential to disclose this information on the Sports Physical form. The physician can provide guidance on how the condition may affect participation in sports. Depending on the situation, there may be recommendations for restrictions or additional evaluations. Open communication with the medical professional is key to ensuring the athlete's safety.

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Sports Physical 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: _________________________________________________________________

__________________________________________________________________________________________________