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Canada Soccer Concussion Assessment Medical Report

Canada Soccer Concussion Assessment Medical Report 2026

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The Canada Soccer Concussion Assessment Medical Report is a form designed for medical professionals to communicate an athlete's concussion diagnosis and status to their team staff after a soccer-related impact. It includes consent for disclosing personal health information, physician assessment options regarding the athlete's ability to participate in activities, and outlines strategies for gradual return to school and sport following a concussion. The document emphasizes the importance of monitoring symptoms and obtaining medical clearance before resuming full contact activities.

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Click ‘Get Form’ to open the Canada Soccer Concussion Assessment Medical Report in the editor.
Begin with the 'Consent to Disclose Personal Health Information' section. Ensure that the athlete, parent, or guardian fills in their name and authorizes the disclosure of personal health information by signing and dating the form.
Proceed to the 'Physician Assessment' section. The medical professional should check one of the options regarding the concussion diagnosis and provide their signature, printed name, and date.
Review any additional sections related to return-to-school and return-to-sport strategies. These sections outline steps for gradual reintegration into activities based on symptom resolution.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (67 Votes)

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Can chiropractors diagnose concussions in Canada?

Chiropractors have the clinical training to assess, diagnose and manage a concussion or mild traumatic brain injury (mTBI).

What is the Canada Soccer Code of Conduct and Ethics?

The purpose of the Canada Soccer Code of Conduct and Ethics is to ensure a safe, positive, inclusive and ethical environment within Canada Soccers organization, programs, activities, and events. All Constituents are expected to demonstrate appropriate behaviour consistent with Canada Soccers values.

Who is the concussion expert in Canada?

The CCC is led by internationally acclaimed concussion expert, Dr. Charles Tator.

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Who can diagnose concussion in Canada?

A medical doctor or nurse practitioner can provide a thorough assessment, concussion diagnosis and manage your condition. They can also evaluate when you can safely return to play and the provide medical clearance for you to do so.

What is the protocol for a concussion in soccer?

Doctors and other concussion specialists agree that a player must not return to play until symptoms are completely gone, both at rest and during exercise or exertion. Using medicine to improve concussion symptoms is not the same thing as being symptom-free.

Who is allowed to diagnose a concussion?

Emergency Room Doctor In most cases, the emergency room will be your first stop for a suspected serious injury. While some people go to the ER for a possible concussion, the most the ER team can do is diagnose your injury and confirm it isnt more serious.