Pre-Participation Physicals & Forms

All Athletes MUST provide verification of their sickle cell trait status prior to participation. See form below.

All new athletes are required to complete a health history and insurance questionnaire, provide verification of their sickle cell trait status and have a comprehensive physical exam prior to participation in athletic activities at Long Beach State. The physical exam includes:
1) General Medical Exam
2) Orthopedic Exam
3) Lab Work

General Medical Exam
Athletes have three options to complete their general medical exam:

• 1. Schedule an appointment with team physicians during the summer (free)
• 2. See their own physician, at athlete's expense**
• 3. Attend the physical date for your sport listed below

**Athletes must use the forms below when they see their physician.

Appointments for general medical physicals with our team physicians can be made anytime during the summer by calling Dr. Drum & Chrysanthis' office at (562) 795-6406 and tell them that you are an athlete.

Orthopedic Exam
Orthopedic exams will take place during the scheduled physical time for each team listed below.

Lab Work
Each athlete will have blood work (CBC) and Urinanalysis (UA) performed. Testing will be completed at the Student Health Center on campus or may be completed by personal physician if preferred. (Copy of results must be submitted with other paperwork.)

Physical Dates:

Date	Time	Sport
Tuesday, August 3	3:30 p.m.	Women's Soccer
Sunday, August 8	TBA	Women's Volleyball
Wednesday, August 18	3:30 p.m.	Men's Water Polo, Women's Cross Country
Thursday, August 26	3:30 p.m.	ALL Sports
Wednesday, September 1	3:30 p.m.	ALL Sports
LOCATION: Athletic Training Room - PE Building Room 86

Complete forms can be turned in on the assigned physicals date OR mailed to the athletic training room:
Long Beach State Athletic Medicine
Attn: Shauna Horton
1250 Bellflower Blvd
Long Beach, CA 90840

Contact Shauna Horton, with any questions: (562) 985-5222 or shorton@csulb.edu

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ALL NEW STUDENT ATHLETES

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are required to attend the assigned physical date regardless of whether you have obtained a physical on your own.

***If any athlete has had any injuries or illnesses that required surgery or ongoing care, please include copies of documentation regarding treatment( op notes, clinic notes, lab reports etc.).

Required Forms for All NEW Athletes:
New Athlete Medical History
General Medical Exam
Orthopedic Evaluation
Insurance Questionnaire
Explanation of Insurance
Authorization of Treatment (if under 18)
Informed Consent Form
Sickle Cell Trait Form

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RETURNING ATHLETES

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All Athletes must provide verification of their sickle cell trait status prior to participation. See form below.

All returning athletes are required to complete a health history, insurance and informed consent form each year prior to participation. These forms are available below.

• If you had an injury/illness over the summer, please indicate this on your health history form with details and provide any supporting documentation (doctor's notes, test results, etc.)
• If you would like to be seen by a doctor prior to participation, please indicate this on your health history form and notify a staff athletic trainer.

These forms must be completed and returned to the training room in person or by mail. All forms will need to be reviewed to be cleared for participation. Athletes will be cleared to participate based on this review by he staff athletic trainer and/or team physician(s).

Required Forms for All RETURNING Athletes:
Returning Health History
Insurance Questionaire
Explanation of Insurance
Informed Consent Form
Sickle Cell Trait Form

Contact Shauna with any questions: (562) 985-5222 or shorton@csulb.edu

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