Medical Certificate For Competitive Athletics Template

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MEDICAL CERTIFICATE FOR COMPETITIVE ATHLETICS
It is compulsory to fill every part of this form and the doctor’s signature and stamp.
City and date ________________________________________________________
Mr/Mrs (name, surname)_______________________________________________
Date of birth__________________________________________________________
Nationality___________________________________________________________
Resident at (address, city country) ________________________________________
ID Document n°_______________________________________________________
The athlete has required the medical examination for competitive athletics.
According to the results required by Italian law of:
- medical examination
- complete urine analysis
- -electrocardiogram rest and after exercise
- spirometry
the athlete is healthy and currently fit for competitive athletics.
This certificate is valid until (date) _____________________________ (The certificate must be valid at least
until April 2, 2017 included)
Doctor’s signature______________________________
Doctor’s stamp_________________________________

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