Form Templates
Updated
by
Niki Budd
Form Templates
We have some pre-made forms to help get you started. Feel free to choose one and tweak/customize it all you want. Or, use one as-is and get started collecting forms right away!
Pre-Participation:
- ADHD Medical Exceptions Notification Form
The NCAA Medical Exception Documentation Reporting Form to Support the Diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and Treatment with Banned Stimulant Medication. - Assumption of Risk
This form is an assumption of risk, release, and waiver of liability, and consent is used for participants in athletics. - Authorization to Obtain & Release Medical Information
This form is used to receive authorization to obtain and release medical information. - Combined Medical History- Incoming/Returner
Medical History document that is specific to conditional groups in one document. Returners will complete the “Returning Student Athlete Physical” and incoming athletes will complete the “Incoming Detailed Medical History” - Concussion Awareness Form
Information for Student-Athletes and Parent/Guardians. Contains educational info and allows both athlete and parent/guardian to sign in agreement to show that they have received and agree to the information. - Consent to Treat
The consent to treat form gives providers permission to treat their child when he or she is in someone else's care. - Detailed Student Athlete Medical History Questionnaire
A comprehensive medical history questionnaire, intended for initial intake of medical history. - HIPAA Release Form
This form is used to obtain consent from a patient before their protected health information can be shared for non-standard purposes - NCAA Concussion Fact Sheet for Student Athletes
Fact Sheet for Student Athletes to read and sign - NCAA Sickle Cell Trait Fact Sheet
NCAA Sickle Cell Trait Fact Sheet for Student Athletes to read and sign - Preparticipation Physical Evaluation
Preparticipation Physical Evaluation with biometric, vision, MSK, and Medical Review. To be completed via Physician. - Returning Student Athlete Physical
This form is to be with returning student-athletes who are required to complete an update to their medical history. - Sickle Cell Information & Documentation
NCAA Sickle Cell Trait Testing Information Form - allows students to request one of 3 options:- Sickle Cell Trait testing
- Agree to provide proof of prior testing
- Elect to not proceed with testing
- Student-Athlete Demographics & Emergency Contact Form
This template gathers basic information of the student-athlete which includes address, medical insurance information, and emergency contact information.
Wellness:
- General Screening Index
This template gathers information about a student-athlete's mental well-being. - Return-To-Play Daily Progression
Daily documentation for concussion return to play monitoring - Wellness Survey
Universal survey accessing everything wellness for inside and outside school and sports
Other:
- Affidavit of Parental Consent for Student Athlete to Complete Required Documents on their Behalf
Parent/Legal Guardian document intended to release the parent from signing all required document with Student Athlete at the same time - Athletic Insurance Questionnaire
Student Athlete Insurance Information - Insurance Information
Collection of Insurance Information, intended for non-athletic population - Substance Abuse/Misuse and Consent to Drug Testing
The purpose of this document is to acknowledge drug education training and outline consent to drug testing
Patient Reported Outcomes:
These templates house auto-calculations to give the provider a quick scoring, please reference: From Builder Templates with Pre-Calculated Values to learn more.
