Pediatric and Adolescent Medicine

Sports and Other Activity Screening Examination Pre-Visit History Form

Does your child participate in sports leagues at his or her school? Maybe he or she is considering another activity like karate or dance.
Although required by the Wisconsin Interscholastic Athletic Association (WIAA), it's a good idea to have your child undergo a sports/activity screening examination before beginning any new regular activity.
Sports and other activity screening examinations include a pre-visit questionnaire to be completed by the athlete and parent. The "Preparticipation Physical Evaluation History Form" is mailed ahead of time with patient reminder letters. However, the form is also available via the link below.
If you have any questions about this form or activity screening exams, please call your clinic. Remember to schedule activity exams well in advance to avoid delays in your child's participation. 

Preparticipation Physical Evaluation History Form (pdf)