Get the free ATHLETE SUPPLEMENTAL HEALTH FORM - Middlebury College - middlebury

ATHLETE SUPPLEMENTAL HEALTH FORM Must be completed and returned within 6 months of start of first athletic season Name LAST FIRST Return this Health Form (no substitutions) to: PARTON HEALTH CENTER

How to fill out athlete supplemental health form

How to fill out athlete supplemental health form:

1. Obtain the form: Contact the relevant sports organization, school, or team to request the athlete supplemental health form. It may be available in physical or electronic format.
2. Read the instructions: Carefully go through the instructions provided on the form. The instructions will give you guidance on how to complete each section and what information is required.
3. Personal information: Begin by filling out your personal information accurately. This typically includes your full name, date of birth, address, phone number, and email.
4. Medical history: Provide comprehensive details about your medical history. This includes any previous injuries, surgeries, illnesses, or medical conditions you have experienced. Be honest and thorough while describing your medical background.
5. Insurance information: If you have health or supplemental insurance, fill in the necessary details. You may need to provide policy numbers, group numbers, or any other relevant insurance information.
6. Emergency contact: Provide the name, relationship, phone number, and address of your emergency contact person. This individual should be someone who can be reached in case of any medical emergencies.
7. Consent and authorization: Carefully review the consent and authorization section. By signing this, you are giving permission to the sports organization or team to seek medical treatment on your behalf if necessary.
8. Parent or guardian signature: If you are a minor, ensure that a parent or guardian reviews the form and signs it as well. Their signature indicates their consent and approval for your participation in sports activities.
9. Submitting the form: Once you have completed all the required sections, ensure the form is legible and accurate. Make copies of the form for your records, if necessary. Return the completed form to the appropriate organization or team by the specified deadline.

Who needs athlete supplemental health form:

1. Athletes participating in organized sports: The athlete supplemental health form is typically required for individuals participating in organized sports such as school athletics, recreational leagues, or professional teams.
2. Minors participating in sports activities: In many cases, if the athlete is a minor, their parent or guardian will also need to complete and sign the form to provide consent and necessary medical information.
3. Athletes with pre-existing medical conditions: The form allows athletes to disclose any pre-existing medical conditions, ensuring that the sports organization or team is aware of any potential health risks and can provide adequate support and care if needed.
4. Athletes without primary health insurance: The form may also inquire about insurance coverage. Athletes who do not have primary health insurance or supplemental insurance may need to provide additional information or seek coverage options through the sports organization or team.

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What is athlete supplemental health form?

The athlete supplemental health form is a document that gathers information on an athlete's health history, current health status, and medical insurance coverage.

Who is required to file athlete supplemental health form?

All athletes participating in a sports program or event that require proof of medical clearance and insurance coverage are required to file the athlete supplemental health form.

How to fill out athlete supplemental health form?

Athletes can fill out the form by providing accurate and detailed information about their health history, current health conditions, and medical insurance coverage. The form should be signed and dated by the athlete.

What is the purpose of athlete supplemental health form?

The purpose of the athlete supplemental health form is to ensure that athletes participating in sports programs or events are physically prepared and have appropriate medical insurance coverage in case of injury.

What information must be reported on athlete supplemental health form?

The athlete supplemental health form typically requires information such as past medical conditions, current medications, allergies, emergency contacts, and insurance information.