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Begin by filling out Part 1 with the athlete's personal information, including their name, social security number, sex, age, birthdate, school or organization, city, coach's name, and phone number.
In Part II, read the note to the examining physician regarding Atlantoaxial Subluxation. Ensure that cervical spine x-rays are included as required.
Proceed to Part III where the examining physician must check either 'Negative' or 'Positive' regarding Atlantoaxial Subluxation based on the x-ray results. If positive, ensure all relevant activities are checked in Part IV.
In Part IV, check all activities that the athlete may participate in year-round. Be mindful of high-risk sports if there is a positive indication of Atlantoaxial Subluxation.
Finally, have both the examining physician and family physician sign and print their names in Part V along with the date and address.

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