Sports Medicine Intake Form
Intake

Sports Medicine Intake Form

3 pages16 fieldsHIPAA-ready

Form preview

formisoft.com/f/sports-medicine-intake
Sports Medicine Intake Form
Athlete Information
Sport & Position
Competition Level
Select...
Current Injury/Complaint
Mechanism of Injury
Select...
Previous Sports Injuries
Concussion History
Training Regimen
Pain Level (0-10)
Return-to-Play Goals
Consent to Treatment
Sign here
Submit

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.

Athlete InformationText
Sport & PositionText
Competition LevelDropdown
Current Injury/ComplaintLong Text
Mechanism of InjuryDropdown
Previous Sports InjuriesLong Text
Concussion HistoryCheckbox
Training RegimenLong Text
Pain Level (0-10)Multiple Choice
Return-to-Play GoalsLong Text
Consent to TreatmentE-Signature

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

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