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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.

Before your arrival on campus the following items are needed for you to be cleared by our medical staff:
Athletic Information and Health Questionnaire Get Acrobat Reader
Insurance QuestionnaireGet Acrobat Reader along with a front and back copy of your current health insurance card.
Mercy Hospital - Springfield Patient Registration formGet Acrobat Reader
Copies of any pertinent medical records (guidelines i.e. any surgeries or major injuries in past 5 years)
     · Failure to provide these records will delay your clearance to participate
Copies of documentation on ADD/ADHD diagnosis and medication (if applicable)
     · Failure to provide this documentation may jeopardize your eligibility per NCAA policies

Upon your arrival on campus, the following items are needed for you to be cleared by our medical staff:
Physical with our team physician (this cannot be scheduled until the above information has been completed and received)
Sickle Cell Test or waiver
Injury/Illness Reporting Agreement
Authorization for Disclosure of Patient Medical/Health Information

Once you are cleared to participate as a student-athlete you will complete the following screens:
Functional Movement Screening (FMS) with Mitch Hauschildt, ATC, our Rehabilitation Coordinator/Injury Prevention Specialist
Concussion Baseline Screen with the Athletic Trainer with your sport

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