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Click ‘Get Form’ to open the inz 1014 in the editor.
Begin by entering your name, ID number, and the sport/semester details at the top of the form. This information is essential for identification.
Carefully answer each medical history question using 'Y' for yes, 'N' for no, and '?' for unsure. Ensure accuracy as this information is crucial for your health assessment.
For any questions that require additional details, such as past injuries or medical conditions, provide clear and concise explanations in the designated spaces.
Once you have completed the first page, sign and date the form at the bottom to confirm that all information is true to your knowledge.
After filling out your section, take the form to your healthcare provider for completion of their section on page two.
Finally, return the completed form to the Athletic Trainers at Eastern Connecticut State University or fax it as instructed.

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