Medical Diagnostics Form For Athletes With Visual Impairment printable pdf download

Medical Diagnostics Form For Athletes With Visual Impairment

MEDICAL DIAGNOSTICS FORM FOR ATHLETES WITH

VISUAL IMPAIRMENT

This form must be completed by every individual athlete with visual

impairment

and

pages

1-3

must

submitted

the

respective

International Federation (IF, see page 5) before classification.

The form is to be filled out by a registered ophthalmologist (as applicable

by country).

The form is used to determine the athlete’s sight in accordance with the

respective IF classification rules (eligibility criteria listed on page 4 as a

reference).

Please fill out the form legibly and in capital letters.

Incomplete Applications will be returned and will need to be re-submitted.

Athletes cannot present for classification until applications have been

completed.

1. ATHLETE INFORMATION

First Name:

Last Name:

Date of Birth

Gender:

Female

Male

(d/m/y):

Address:

City:

Country:

Sport:

2. MEDICAL INFORMATION

Current diagnosis with sufficient medical information (see note 1):

Medical Diagnistocs Form for Athletes with Visual Impairment

Page 1 of 5

Medical Diagnostics Form For Athletes With Visual Impairment