Medical Diagnostics Form For Athletes With Visual Impairment
Download a blank fillable Medical Diagnostics Form For Athletes With Visual Impairment in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Medical Diagnostics Form For Athletes With Visual Impairment with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4Medical Diagnostics Form
for athletes with visual impairment
The form is to be completed in English and by a registered ophthalmologist.
All medical documentation required on pages 2-3 needs to be attached.
The form and the attached medical documentation may not be older than 12 months at the time of
the Athlete Evaluation.
Athlete Information
Last name:
First name:
Gender:
Female
Male
Date of Birth:
Sport:
IF registration ID
NPC/NF:
(if applicable):
Medical Information
Diagnosis:
Medical history:
Age of onset:
Anticipated future
procedure(s):
Athlete wears
yes
no
Correction:
Right:
glasses:
Left:
Athlete wears
yes
no
Correction:
Right:
contact lenses:
Left:
Athlete wears eye
right left
prosthesis:
Medication:
Eye medications
used by the athlete:
Ocular drug allergies:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical