This form will be forwarded directly to ISA Chief Medical Officer, Dr Asher Livingston.
Sections to be Completed:
Section 1 - Contact Information
Section 2 - Medical Details
Section 3 - Athlete Declaration
Please ensure all sections are completed before submitting.
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:
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.