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Home  •  Staff  •  Forms  •  Visiting AT  •  Curriculum  •  Staff Vacancy

ATHLETIC MEDICAL AND REHABILITATION SERVICES FORMS

FRESHMEN AND INCOMING ATHLETES

Welcome to Missouri State University! We are excited for your arrival on campus. Parents, please refer to the Important Information for Athletes and Parents Get Acrobat Reader for more specific information regarding health care coverage for Missouri State athletes.

The following items are needed in this order for you to be cleared by our medical staff for participation:
✓ Athletic Information and Health Questionnaire Get Acrobat Reader and a front and back copy of your health insurance card. Please return completed form and copies to the address or fax number at the bottom of the page.
✓ Pre-register with Mercy Hospital - Springfield by filling out the Mercy Hospital - Springfield Patient Registration formGet Acrobat Reader. You can either fax the form in or call directly.
✓ Copies of any pertinent medical records (significant injuries/illnesses, surgery notes, etc.)
✓ Copies of documentation on ADD/ADHD diagnosis and medication (if applicable)
✓ Physical with our team physician, Dr. Brian Mahaffey.
✓ Sickle Cell Test or waiver
✓ Functional Movement Screening with Mitch Hauschildt, ATC- not a requirement

RETURNING STUDENT ATHLETES

Welcome back! Please update Athletic Medical and Rehabilitation of any changes in your personal health insurance by providing us with an updated front and back copy of your insurance card.

Also, please help us streamline your returning physical by filling out the Athletic Physical Recertification Form Get Acrobat Reader. You should do this when you are notified by your athletic trainer about your physical. Simply type out the form, print it and either deliver to your athletic trainer ahead of time or bring with you to your physical.

EXITING STUDENT ATHLETES

Please print off and return the following form to Athletic Medical and Rehabilitation in the Forsythe Athletic Training Room or to the address at the bottom of the page.
✓ Exit Medical Assessment Acknowledgement Get Acrobat Reader

POLICIES

✓ Athletic Medical and Rehabilitation Services Policies Get Acrobat Reader


Athletic Medical and Rehabilitation
901 South National
Springfield, Missouri 65897
(417) 836-5461 Office
(417) 836-6101 Fax