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Athlete Physical Forms

On behalf of the Wright State University Sports Medicine Staff, I would like to welcome you to Wright State University. In an effort to better serve our student-athletes, all physical forms are posted online under the appropriate heading. You may click on the appropriate link and fill the forms out on the computer. After you have completed the forms, please print them off, sign them and return them to the address below:

Jason Franklin ATC
3640 Colonel Glenn Hwy.
Nutter Center #356
Dayton, OH 45435

These forms provide us with vital information about your health and well being. Please take your time and fill them out completely and honestly. Your health and safety is our primary concern. All information is kept confidential and will only be disseminated as allowed by law and when necessary. Please return the forms by the dates listed below:

Fall Sports July 15

Winter/Spring Sports August 1

*These forms are different from the forms required by the university health. Please do not assume I already have this information as we are two separate entities.

Below is a checklist for completing all forms for the Wright State University Sports Medicine Staff:

1. Complete and sign with son/daughter the Wright State University medical history and pre-participation forms (annual questionnaire if returning)

2. Read and understand the medical insurance coverage

3. Complete and sign the annual insurance form for the 2009-10 school year

      a. You must attach a front/back copy of your card

4. Complete and sign all release forms:

      a. FERPA

      b. HIPPA

      c. Drug Testing/Athlete Assistance Program

      d. ADD/ADHD

5. Enclose all the signed documents into an addressed envelop and mail by the assigned date.

      a. If you are currently being treated for any injuries, please send current documentation

      b. If you have ever seen a physician for any cardiac reason, a copy of reports and dictations will need to be sent

Should you have any questions, please call me at (937) 775-2776. Once again thank you and welcome to Wright State University.

Returning Athlete Physical Forms 

Newcomer Athlete Physical Forms 

Tryout (Walk-On) Athlete Physical Forms 

Insurance Forms 

Release Forms 

Physical Dates