• Ice Skating Australia Incorporated

    Ice Skating Australia Incorporated

    Affiliated to the International Skating Union
  •  This form will be forwarded directly to ISA Chief Medical Officer, Dr Asher Livingston.

  • Medical Questionnaire

    CONFIDENTIAL
  • Sections to be Completed:

    Section 1 - Contact Information

    Section 2 - Medical Details

    Section 3 - Athlete Declaration 


    Please ensure all sections are completed before submitting.

  • Section 1 - Contact Information

  • Athlete Contact

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  • Next of Kin
  • Section 2 - Medical Details

  • Medical Conditions

  • Vaccinations

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  • Injuries

    Please specify any type of injury which prevented you from training for more than a week during the last 12 months; for example; Head Injury / Shoulder / Elbow / Wrist / Back / Hip / Knee / Other:

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  • Section 3 - Athlete Declaration

  • To the best of my knowlegde, all the information contained on this sheet is correct. I understand I am ultimately responsible for my own health and well-being and professional medical advice should be sought for any sporting activity injury.

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  • Reload
  • Should be Empty: