Sports Medicine Intake Form
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The Sports Medicine Intake Form is tailored for sports medicine physicians, athletic trainers, and performance medicine clinics. It goes beyond standard orthopedic intake to capture athletic-specific information: sport and position played, training regimen and volume, competition level, previous sports injuries with return-to-play timelines, and concussion history.
The concussion history section uses a structured approach to document previous head injuries, symptoms experienced, and recovery timelines. This information is critical for managing current head injury presentations and determining return-to-play protocols. The injury assessment section captures mechanism of injury with sport-specific contexts (contact, non-contact, overuse).
Performance goals and return-to-play expectations are documented collaboratively with the athlete, establishing clear benchmarks for rehabilitation progress. The form also captures nutritional habits, supplement use, and sleep patterns -- factors that significantly influence injury recovery and prevention. This template serves both the treatment and prevention sides of sports medicine.
What's included
- Athletic history and competition level
- Sport-specific injury assessment
- Concussion history documentation
- Training regimen and volume tracking
- Return-to-play goals and timelines
- Nutritional and lifestyle assessment
- E-signature capture
Who uses this template
- Sports medicine physicians and clinics
- Athletic training facilities
- College and professional team medical staff
- Performance and rehabilitation centers
All form fields
13 fields across 3 pages. Customize any field after signing up.
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