Homepage Free Sports Physical Template
Table of Contents

The Sports Physical form is a vital document designed to ensure that young athletes are fit to participate in sports activities. This form collects essential information about the athlete, including personal details such as name, date of birth, and contact information for parents or guardians. It also emphasizes the importance of disclosing any medical alerts, such as allergies or existing health conditions, which can significantly impact an athlete's safety during physical activities. The medical history section is particularly crucial, as it prompts athletes and their families to provide comprehensive answers regarding past injuries, family health history, and any ongoing medical concerns. A licensed physician is required to complete the physical examination section, assessing various health parameters like height, weight, and cardiovascular health. The physician also evaluates the athlete's musculoskeletal system to identify any potential issues that could hinder performance or pose risks during sports participation. Ultimately, this form not only serves as a health record but also plays a critical role in safeguarding the well-being of young athletes.

Document Specifics

Fact Name Description
Purpose The Sports Physical form assesses an athlete's health and readiness for participation in sports.
Medical History Importance It includes a comprehensive medical history to identify any potential risks of injury.
Emergency Contact It requires the names and contact information of parents or guardians for emergency situations.
Medical Alerts There is a section for noting any medical alerts, such as allergies or existing conditions.
Physician's Role A licensed medical professional must complete the physical examination section of the form.
State-Specific Requirements Different states may have specific laws governing the use of the Sports Physical form, such as the requirement for a physician's signature.
Age Requirement Typically, athletes under a certain age (often 18) are required to have this form completed before participating in school sports.
Confidentiality The information on the form is confidential and should be handled with care to protect the athlete's privacy.

Similar forms

  • Medical History Form: Similar to the Sports Physical form, the Medical History Form collects detailed health information about an individual. It includes questions about past illnesses, surgeries, and family medical history. This document is essential for understanding a patient's overall health and potential risks, especially in a clinical setting.

  • Consent to Treat Form: This document is often used in healthcare settings to obtain permission from a patient or guardian for medical treatment. Like the Sports Physical form, it requires signatures and personal information. It emphasizes the importance of informed consent and ensures that individuals understand the medical procedures they may undergo.

  • Emergency Contact Form: The Emergency Contact Form is similar in that it collects vital contact information for family members or friends in case of an emergency. This form, like the Sports Physical form, ensures that the necessary people can be reached quickly if a medical issue arises during sports or other activities.

  • Living Will Form: To ensure your healthcare preferences are respected, consider the comprehensive Living Will documentation that outlines your wishes for medical treatment when you cannot communicate them yourself.
  • Immunization Records: Immunization Records document vaccinations an individual has received. This form is crucial for ensuring the health and safety of athletes, similar to the Sports Physical form. Both documents help assess readiness for participation in sports and other group activities by confirming that an individual is protected against certain diseases.

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: _________________________________________________________________

__________________________________________________________________________________________________

__________________________________________________________________________________________________

Understanding Sports Physical

What is the purpose of the Sports Physical form?

The Sports Physical form is designed to assess an athlete's health and fitness level before participating in sports. It helps identify any potential health risks or medical conditions that could affect the athlete's performance or safety. Completing this form ensures that athletes are medically cleared to engage in physical activities.

Who needs to complete the Sports Physical form?

All athletes, regardless of age or sport, are required to complete the Sports Physical form before participating in any athletic activities. This includes students in middle school, high school, and even younger athletes involved in organized sports. Parents or guardians should assist younger athletes in filling out the necessary information.

What information is required on the form?

The form requires personal information such as the athlete's name, gender, date of birth, and contact details for parents or guardians. Additionally, it includes a section for medical alerts, medical history, and a physical examination by a licensed medical professional. This comprehensive information is crucial for evaluating the athlete's health status.

What should I do if I answer "Yes" to any health history questions?

If you answer "Yes" to any of the health history questions, it is important to provide detailed explanations in the designated area of the form. This information will help the physician assess any potential risks. Be prepared to discuss these issues further during the physical examination.

Who can conduct the physical examination?

The physical examination must be conducted by a licensed medical physician, physician’s assistant, or family nurse practitioner. It is essential to ensure that the healthcare provider is qualified to evaluate the athlete's health. Chiropractors, however, are not considered satisfactory for this requirement.

How often do athletes need to complete the Sports Physical form?

Athletes typically need to complete the Sports Physical form annually, or whenever there is a significant change in their health status. This ensures that any new medical conditions or concerns are taken into account before the athlete participates in sports activities.

What happens if an athlete has a medical condition?

If an athlete has a medical condition, it is crucial to disclose this information on the form. The physician will evaluate the condition and determine if any participation restrictions are necessary. This helps ensure the athlete's safety and well-being while participating in sports.

What are participation restrictions?

Participation restrictions are specific limitations that may be placed on an athlete based on their medical evaluation. These could include modified activities, limited participation, or complete disqualification from certain sports. The physician will outline any restrictions on the form after the examination.

Where can I obtain the Sports Physical form?

The Sports Physical form can usually be obtained from your school’s athletic department, local sports leagues, or online through various health and wellness websites. Ensure you have the most current version of the form to avoid any issues during the submission process.

Dos and Don'ts

Filling out a Sports Physical form is an important step for any athlete. It helps ensure their health and safety while participating in sports. Here are five things you should and shouldn't do when completing this form.

  • Do read the entire form carefully. Understanding each section will help you provide accurate information.
  • Do provide complete and honest answers. Your responses are crucial for the physician's assessment of the athlete's health.
  • Do check for any medical alerts. If there are allergies or other medical conditions, make sure to note them clearly.
  • Do ask questions if you're unsure. If anything on the form is confusing, don’t hesitate to reach out for clarification.
  • Do keep a copy of the completed form. Having a record can be helpful for future reference.
  • Don’t rush through the form. Taking your time can prevent mistakes and omissions.
  • Don’t leave any sections blank. Incomplete forms can delay the physical examination process.
  • Don’t exaggerate or downplay health issues. Be truthful about the athlete’s medical history to ensure their safety.
  • Don’t forget to include emergency contact information. This is vital in case of an emergency during sports activities.
  • Don’t forget to have the physician sign the form. An unsigned form will not be accepted.