Pre-participation Physical Evaluation History Form - Mesalands 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date of the exam at the top of the form. This helps track when the evaluation was conducted.
3. Fill in your personal information, including your name, sex, age, and date of birth. Ensure accuracy for identification purposes.
4. Provide your address and phone number for contact. This is essential for any follow-up communication.
5. List your personal physician's name for reference during medical evaluations.
6. In case of an emergency, fill out the contact information for someone who can be reached immediately.
7. Carefully answer each health-related question by circling 'Yes' or 'No'. If you answer 'Yes', provide explanations in the designated area below.
8. For female participants, complete additional questions regarding menstrual history as required.
9. Finally, sign and date the form to confirm that all provided information is accurate and complete.

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