Sports Medicine General Pre-Participation Form, Assumption of Risk, Consent to Receive Medical Care, and HIPAA Release 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling in your name and the name of the college or university at the top of the form. This personalizes your document and ensures it is correctly associated with your athletic participation.
  3. In the Assumption of Risk section, read through the statement carefully. Initial next to the statement to indicate your understanding and acceptance of the risks involved in athletic activities.
  4. Proceed to the Consent to Receive Medical Care section. Here, authorize medical personnel by initialing after reading about their authority to evaluate and treat injuries during your participation.
  5. In the HIPAA Release section, review how your health information may be shared. Initial after understanding that this consent is necessary for participation as an intercollegiate athlete.
  6. Finally, sign and date at the bottom of the form. Ensure all fields are completed before submitting.

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I, , the undersigned, hereby consent to participate in physical exercise tests and do further consent to participate in various activities in association therewith. I further acknowledge and agree that I have been apprised of the nature of the activities which I shall participate in.
The National Sports Medicine Institute is required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to maintain the privacy of Protected Health Information and to provide our patients with this Notice, outlining our legal duties and privacy practices with respect to their Protected Health
A process in which patients are given important information, including possible risks and benefits, about a medical procedure or treatment, genetic testing, or a clinical trial. This is to help them decide if they want to be treated, tested, or take part in the trial.
An informed consent document aims to inform the client of the potential risks from partaking in exercise and their own responsibility for their actions. From this, clients must sign the informed consent.
Informed consent allows for the maintenance of patient autonomy and is essential in establishing trusting relationships between physicians and their patients. This process involves thorough discussion of the risks and alternatives, as well as the short- and long-term outcomes, of proposed treatment options.

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a statement that participation is voluntary, that consent has been freely obtained, and that subjects may withdraw at any time without fear of sanction.

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