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Healthcare & Wellness
Sports Physical Clearance
The pre-participation physical for school and club athletes — registration, a structured health history, and physician clearance with parent sign-off.
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Preview · not interactiveSports Physical Clearance
The pre-participation physical for school and club athletes — registration, a structured health history, and physician clearance with parent sign-off.
The athlete
Athlete's name*
Date of birth*
Pick a date📅
School / club and team*
e.g. Northside High — U16 football
Which sports will they play this season?*
Football / Soccer
Basketball
Volleyball
Athletics / Track & field
Parent / guardian phone*
Our first call if anything comes up during practice or a game.
Health history
Has the athlete ever experienced any of the following?*
YesNoFainting or dizziness during exerciseChest pain during or after exerciseA concussion or significant head injury
Current medications (optional)
Allergies (optional)
e.g. penicillin, bee stings, nuts
Date of last physical exam
Pick a date📅
Approximate is fine if you are not sure.
Clearance & sign-off
Examining physician*
Name and clinic
Clearance status*
Cleared — full participation
Cleared with restrictions
Not cleared
Restrictions or follow-up required
Parent / guardian consent*
Parent / guardian consent
Parent / guardian signature*
Sign here
Physician signature*
Sign here
Confirms the examination and the clearance status above.
Submit