Sports Participation Medical Screening Form
First name
Last name
Birthday
Month
Day
Year
Sport(s)
Email (this is where your form will be returned)
List past and current medical conditions
Have you ever had surgery? If yes, list all past surgical procedures
Medicines and supplements: List all current prescriptions, over-the-counter medicines, and supplements (herbal and nutritional).
Do you have any allergies? If yes, please list all your allergies (ie, medicines, pollens, food, stinging insects).
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Sports Participation Medical Screening Form