
Form preview

The Sports Medicine Intake Form is tailored for sports medicine physicians, athletic trainers, and performance medicine clinics. It goes beyond standard orthopedic intake to capture athletic-specific information: sport and position played, training regimen and volume, competition level, previous sports injuries with return-to-play timelines, and concussion history.
The concussion history section uses a structured approach to document previous head injuries, symptoms experienced, and recovery timelines. This information is critical for managing current head injury presentations and determining return-to-play protocols. The injury assessment section captures mechanism of injury with sport-specific contexts (contact, non-contact, overuse).
Performance goals and return-to-play expectations are documented collaboratively with the athlete, establishing clear benchmarks for rehabilitation progress. The form also captures nutritional habits, supplement use, and sleep patterns -- factors that significantly influence injury recovery and prevention. This template serves both the treatment and prevention sides of sports medicine.
What's included
- Athletic history and competition level
- Sport-specific injury assessment
- Concussion history documentation
- Training regimen and volume tracking
- Return-to-play goals and timelines
- Nutritional and lifestyle assessment
- E-signature capture
Who uses this template
- Sports medicine physicians and clinics
- Athletic training facilities
- College and professional team medical staff
- Performance and rehabilitation centers
All form fields
11 fields across 3 pages. Customize any field after signing up.
Use this template
Sign up and start customizing the Sports Medicine Intake Form for your practice. 30-day money-back guarantee.
$79.99/mo · 14-day free trial · HIPAA compliant
Related templates

Physical Therapy Intake Form
PT-specific intake with injury mechanism, pain assessment (VAS scale), functional limitations, range of motion goals, and treatment expectations. For physical therapy, sports medicine, and rehabilitation clinics.

Occupational Therapy Intake Form
OT-specific intake covering functional limitations, ADL assessment, hand and upper extremity evaluation, workplace ergonomics, and treatment goals. For occupational therapists, hand therapy, and rehabilitation clinics.

Orthopedics Intake Form
Orthopedic intake covering musculoskeletal complaints, injury mechanism, imaging history, joint function assessment, and surgical history. For orthopedic surgeons and sports medicine practices.