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PHYSICAL & MEDICAL HISTORY FORM
2022-23 SCHOOL YEA
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ALL PHYSICALS MUST BE DATED AFTER APRIL 15th, 2022

PLEASE READ CAREFULLY

#1 - Student Name and ID Number must be filled out correctly or we will be unable to identify your student properly. Often students leave their name blank.

#2 - Explanation of "Clearances"







This must be filled out COMPLETELY by the medical provider.


If it is missing a signature, date or identifying information it will be determined to be an

INVALID PHYSICAL

#3 - Medical provider information

#4 - Incomplete medical histories will be rejected.


Please do not rush this process, an accurate medical history leads to better and accurate care for your student.

CLICK HERE TO ACKNOWLEDGE THESE GUIDELINES AND CON

All participants in Athletics, Marching Band, Cheerleading, Drill Team, and ROTC are required to have a physical on file with the Athletic Training Department

This physical is not clear to particpate until the medical staff recieves clearance for the documented reason. This must be cleared through a note from the referred Dr.

This physical is not clear to particpate until the medical staff recieves clearance for the documented reason. This must be cleared through a note from the referred Dr.

This physical is not clear to particpate until the medical staff recieves clearance from a physician reagrding any underlying cardiac issue.


This is a precautionary measure out of an abuncance of caution, in the best interests of the student, decided in coordination between the sports medicine staff and our team physicians.