Medical Information Form Page 2
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31. Do you have any medical condition that you have received professional medical attention for in the past
two years? If so, please describe.
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2. Has a physician ever denied or restricted your participation in physical activity for any medical reason? If
so, please describe.
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3. Please list all prescription medications you are taking. Please include the dosage if you know it.
___________________________________________________________________________________________
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4. Please list all over‐the‐counter medications that you regularly take. Please include the dosage if you
know it.
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5. Are you allergic to any medications? If yes, please list the medications and what allergic response you
experience after taking the medication.
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6. Have you ever had a seizure?
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Parent category: Legal