Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player


Arizona Sports Concussion Center Forms
Please fill out the forms below and bring them with you to your testing appointment.
If you have never had a concussion, you do not need to fill out Section II in the Registration and Background Information form.
PLEASE be sure to print a copy of your forms for your own personal records prior to submitting any information.
If you prefer to Fax or Email your information, please download the forms below, fill them out, and fax them to: 480-347-2606
Registration & Background Info Form
Registration Form
 
Documents are availabe in Adobe™ PDF.
HIPAA Privacy Info
HIPAA Privacy Information
 
Release of Info
Release of Information
 
Medical Release
Medical Release
 
Excuse from Physical Activity
Excuse from Physical Activity
 
Excuse from School
Excuse from School
 
HIPAA Privacy Authorization Form
HIPAA Authorization Form
 

If you are having trouble viewing the available PDF documents, you might need to update your Adobe Acrobat software.
     
 


Home | About | Services | ImPACT Test | Facts | Concussion? | Calendar | Forms | Links | Video | Contact

muellergraphic.com