Prefer it online? Patients fill it out on their phone before the visit.
Practice name: ______________________________
Sports Medicine Intake Form
Your information
Athlete Information
Phone Number
Email Address
Sport & Position
Competition Level
Current Injury/Complaint
Mechanism of Injury
Additional details
Previous Sports Injuries
Concussion History
Training Regimen
Pain Level (0-10)
- 0
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
- 9
- 10
Return-to-Play Goals
Consent to Treatment
Date
Sports Medicine Intake Form template from formisoft.com. formisoft.com/intake-templates/sports-medicine-intake