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The forms listed below are for student-athlete medical records and are required for all Valparaiso University athletes prior to their participation. These forms need to be completed and returned to the Valparaiso University Sports Medicine department by July 1 of each year.

Click here to download the student-athlete health forms

Mail forms to:
Valparaiso University Sports Medicine
Athletics-Recreation Center
1009 Union Street
Valparaiso IN 46383

• Insurance/Personal Information: Read and complete all of the information needed and then sign. If a student-athlete’s primary insurance coverage is through a HMO or managed care, the Valparaiso University Sports Medicine department strongly encourages the studenth-athlete and/or his/her parent(s)/guardian(s) to change the primary care physician (PCP) to a Valpo team physician or a local physician in the Valparaiso, Indiana area. Changing your son’s/daughter’s PCP to a Valpo area physician will allow your son/daughter to have a network of physicians in the Valparaiso area, as well as avoid likely delays and/or an inability to receive medical care for athletic and non-athletic related injuries.
• Copy of Front and Back of Insurance Card: These need to be sent as a clear and legible copy.
• Health Center Release of Information Form: This needs to be filled out completely.
• Pre-Participation Physical for Freshmen and Transfer Athletes: This must be completed by a U.S. licensed MD/DO. Physicals from nurses or physician assistants are not accepted unless they accompany a signature from an MD/DO. Physicals from a chiropractor are not accepted, with no exceptions.