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Participation Physical Evaluation
HISTORY FORM
(Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.) Name:
Date
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How to fill out 2016-17 physical form

How to fill out 2016-17 physical form
01
Obtain a copy of the 2016-17 physical form from your school or download it from the school's website.
02
Read through the form carefully to understand the information and requirements.
03
Gather all necessary documents and information such as the student's medical history, previous physical examination results, and insurance information.
04
Fill in the personal details section including the student's name, date of birth, address, and contact information.
05
Provide information about any previous medical conditions, injuries, or surgeries the student has experienced.
06
Complete the section regarding the student's medical history, including any current medication, allergies, or chronic illnesses.
07
Ensure that the immunization records are up to date and fill in the relevant section.
08
If required, have the student's doctor perform the physical examination and fill in the corresponding section.
09
Review the completed form for any errors or missing information.
10
Sign and date the form to certify its accuracy and completeness.
11
Submit the filled-out form to the appropriate school authority or designated personnel.
12
Keep a copy of the form for your records.
Who needs 2016-17 physical form?
01
The 2016-17 physical form is typically needed for students who are participating in school sports activities, enrolling in a new school or grade level, or require a physical examination for medical purposes.
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