Preparticipation Physical Evaluation Forms - History and Exam

Submit the completed preparticipation physical evaluation form to your school's athletic department or sports organization. You can email the form to the provided email address or submit it through the online submission form if available. Alternatively, you can fax the form to the provided fax number or deliver a physical copy to the athletic office. Ensure all required sections are completed and signed.

Ensure to submit the preparticipation physical evaluation forms before the start of the sports season. Deadlines may vary based on your school or sports organization, so check with them for specific dates in 2024 and 2025.

The purpose of the preparticipation physical evaluation form is to ensure that athletes are in good health and capable of participating in sports activities. By providing detailed medical history and undergoing a physical exam, potential health risks can be identified and managed. This form helps protect the well-being of athletes and allows medical providers to make informed decisions about their eligibility for sports.

• 1. Name: Field for the athlete's name.
• 2. Exam Date: Field for the date of the examination.
• 3. Date of Birth: Field for the athlete's date of birth.
• 4. Sport(s): Field to list the sports the athlete participates in.
• 5. Sex assigned at birth: Options to select the sex assigned at birth.
• 6. Identified Gender: Options to select the athlete's identified gender.
• 7. Past and Current Medical Conditions: Field to list any past and current medical conditions.
• 8. Surgical Procedures: Field to list all past surgical procedures.
• 9. Allergies: Field to list any allergies the athlete has.
• 10. Current Prescriptions and Supplements: Field to list all current prescriptions, over-the-counter medicines, and supplements.
• 11. Patient Health Questionnaire (PHQ-4): Questions to assess the athlete's mental health over the past 2 weeks.
• 12. General Questions: General health questions to be answered by the athlete.
• 13. Heart Health Questions About You: Questions related to the athlete's heart health.
• 14. Heart Health Questions About Your Family: Questions related to the heart health of the athlete's family members.
• 15. Bone and Joint Questions: Questions about injuries to bones, muscles, ligaments, joints.
• 16. Medical Questions: Additional medical questions regarding the athlete's health.
• 17. Females Only: Questions specifically for female athletes about their menstrual periods.
• 18. Explain 'Yes' answers: Section to explain any 'Yes' answers provided.
• 19. Signature of Athlete: Field for the athlete's signature.
• 20. Signature of Guardian: Field for the guardian's signature if the athlete is a minor.

If you fail to submit the preparticipation physical evaluation form, you may not be allowed to participate in sports activities. This form is crucial for determining your health and safety during sports.

• Ineligibility: You may be deemed ineligible to participate in sports activities without a completed form.
• Health Risks: Unidentified health issues could pose risks during physical exertion.
• Non-Compliance: Failure to comply with school or sports organization requirements.

• 1. Before Sports Season: Complete the form before the sports season starts.
• 2. When Joining New Sports: Use the form when participating in a new sport for the first time.
• 3. Annual Health Check: It may be required annually for ongoing sports participation.