Professional Athlete Neurological Examination Report - tennessee 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the participant’s full name in the designated fields for last, first, and middle names.
3. In the 'HISTORY' section, indicate if there are any medical history concerns that would prevent licensing by selecting 'Yes' or 'No' and providing an explanation if necessary.
4. Proceed to the 'EXAMINATION' section. Fill in details for cranial nerves, motor strength, tone, and range of motion as required. Be sure to note any abnormalities in the provided spaces.
5. Complete the 'GAIT', 'SENSATION', and 'DEEP TENDON REFLEXES' sections by documenting observations accurately.
6. For the 'MENTAL STATUS EXAMINATION', follow instructions carefully to assess cognitive function and record scores accordingly.
7. Finally, ensure that both the examining physician and applicant sign where indicated, along with their printed names and dates.

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