Prefer it online? Patients fill it out on their phone before the visit.
Practice name: ______________________________
Sports Injury Medical History Form
Athlete Name
Date of Birth
____ / ____ / ________
Primary Sport
Competition Level
Current Injury Description
Date of Injury
____ / ____ / ________
Injury Mechanism
Previous Injuries to Same Area
Concussion History
Training Schedule
Sports Injury Medical History Form template from formisoft.com. formisoft.com/intake-templates/sports-injury-medical-history