Team Tryouts Pre-Season Athlete Health Questionnaire
Athlete Name
Date of Birth
Grade/Year
Guardian/Emergency Contact
Medical History
Have you ever been hospitalized for any reason?
Yes
No
Have you had any surgeries?
Yes
No
Current medical conditions (asthma, diabetes, etc.)
List any allergies
Are you currently taking any medications?
Yes
No
Injury History
Have you had any injuries in the past year?
Yes
No
Concussion history
Yes
No
Other Information
Physician's Name
Physician's Phone
Any additional information we should know?