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BOARD OF COOPERATIVE EDUCATIONAL SERVICES OF NASSAU COUNTY HEALTH AND ALLIED SERVICES 12/07 PHYSICAL EXAMINATION STUDENT BIRTH DATE OF EXAM PHYSICAL EXAMINATION: Please return this form to the Health
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Read the instructions provided on the form carefully to understand the necessary information you need to provide.
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Begin by filling out your personal details such as your full name, date of birth, and contact information.
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Next, provide any relevant information about your school or educational institution, including the name, address, and contact details.
05
Fill in the specific purpose of the form, which is for a physical exam in relation to interscholastic sports or athletic activities.
06
Provide the date of the physical exam and the name of the healthcare professional who conducted it.
07
Answer any questions or sections regarding your medical history, including any existing medical conditions, allergies, or medications you are currently taking.
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If required, provide information about any previous injuries or surgeries you have had that are relevant to the physical exam for sports.
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Coaches or representatives from sports teams or athletic departments who require student athletes to undergo a physical exam before participation.
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School administrators or authorities responsible for ensuring the health and safety of students involved in sports or athletic programs.
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Physical Exam Interscholastic Sports Health Form is a medical form that athletes are required to fill out before participating in school sports.
All student athletes who wish to participate in interscholastic sports are required to file the physical exam form.
The form must be completed by a licensed healthcare provider after conducting a physical examination of the student athlete.
The purpose of the form is to ensure that student athletes are in good health and physically fit to participate in sports activities.
The form typically includes information such as medical history, current medications, allergies, physical exam results, and clearance for sports participation.
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