Professional Athlete Medical Screening Form
Personal Details
Full Name
Date of Birth
Sex
Male
Female
Other
Team/Club
Sport & Position
Nationality
Medical History
Current Medical Conditions
Current Medications
Allergies
Surgical History
Injury History
Major Injuries (past & present)
Rehabilitation/Treatments Undertaken
Family Medical History
Any family history of significant illness (e.g. cardiac disease, diabetes, etc.)
Screening Details
Height (cm)
Weight (kg)
Blood Pressure
Resting Heart Rate
Screening Observations
Declaration
I declare that the above information is accurate and complete to the best of my knowledge.
Date