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Muir Orthopedic Specialists 2625 Shad elands Drive Walnut Creek, CA 94598 ×925× 9398585 Participation Physical Evaluation (Page 1 of 2) Part 1. Student Information (The parent or guardian should

How to fill out pre-participation physical evaluation form

How to fill out a pre-participation physical evaluation form:

1. Start by carefully reading through the entire form to understand the information and requirements.
2. Begin by providing your personal information, such as name, age, date of birth, and contact details.
3. Fill in any medical history information asked for on the form, including details about past injuries, surgeries, or medical conditions.
4. Answer any questions regarding allergies or medications you are currently taking.
5. Provide information about your primary healthcare provider, including their name, contact information, and any specialty if applicable.
6. If required, complete the section on immunization history, providing the dates and types of vaccinations received.
7. Sign and date the form to certify that all the information provided is accurate and complete.
8. If necessary, have a parent or guardian also sign the form if you are under 18 years old.
9. Once completed, submit the form to the relevant organization or institution as instructed.

Who needs a pre-participation physical evaluation form?

1. Student-athletes: Most schools and colleges require student-athletes to undergo a pre-participation physical evaluation to ensure their health and fitness for participation in sports.
2. Recreational sports participants: Some recreational sports leagues or organizations may request individuals to complete a pre-participation physical evaluation form to ensure their safety during physical activity.
3. Youth sports participants: Organizations offering youth sports programs may require participants to complete a pre-participation physical evaluation form to minimize the risk of injuries and ensure the well-being of young athletes.
4. Active individuals joining fitness programs or gyms: Certain fitness programs or gyms may request individuals to provide a pre-participation physical evaluation form to assess their physical capabilities and identify any potential health concerns.
5. Individuals participating in organized events or races: Some organized events or races, such as marathons or triathlons, may require participants to undergo a pre-participation physical evaluation to ensure their readiness for the physical challenges involved.

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