Submit the first four (4) forms and print off a copy of the Physical, Health History, and Clearance Form. Please read the NEW information on ADD/ADHD Drugs and print off the forms if they apply to you. These all must be completed before you will be able to participate in any MSU practice!!!
The Minnesota State University’s team physician has made sickle cell testing an optional test. The following form is a waiver for you to fill out. If you choose to have the test done there are two options. One you can have it done at home with your family doctor. Second option is to have the test done here at the Student Health Services on the MSU campus for approximately $16. Have all results sent to the MSU Athletic Training Room.
Please read, sign, and list your sport at the bottom of the page. In signing this document you understand that these injuries are a possibility with participation in athletics at MSU.
Please fill out the Acknowledgement of Insurance Form
The HIPAA privacy practices and consent form allows us to maintain medical records on you while you are here competing for MSU. We keep these records for ten years after you are done participating, so if you are to ever need any information from these records feel free to contact us. Our records are kept confidential and if you do not want us to talk with parents or coaches about your injuries be sure to verbally tell us at the time of your injury. Please initial the first paragraph in three blanks. Then initial the paragraph starting with (Your rights as a patient) about 3/4 of the way down the page. Finally sign your name with today's date, list your sport and the expiration date (a year from today).
This is an explanation of the medical services provided at MSU. There is a brief description of MSU secondary insurance and the athletic training room procedures. Please make sure that you read this in its entirety.
Print off a copy of these forms, then take them with you to your doctor. We will not accept a physical or health history done on any other [PDF] form (59 KiB). Your physical, health history and clearance form need to be completed during the summer before you start competing at MSU, so from May-August. You only need a physical your first year competing at MSU. These forms must be signed and dated by the physician who performed the physical and sent in by August 1st. Mail it to Sarah Downey at the address listed below.
[PDF] NCAA ADHD Evaulation Form (40 KiB)
[PDF] Adult ADHD Self-Report Instructions and Scale Form (35 KiB)
The NCAA has set guidelines for users of medication to control ADD and ADHD symptoms due to an increase of this type of medication abuse. If you are currently taking this type of medication we need to have specific documentation stating that you have gone through the proper testing on file in the athletic training room. If we do not have this documentation and an NCAA drug test is done and comes back positive you will be guilty regardless of the physician’s prescription. Please print out the NCAA guidelines and self reporting form and take that to your prescribing physician. Then mail all the documentation including test results that pertains to your ADD and ADHD to Sarah Downey at the address below.
If you have any questions please contact Sarah Downey, Assistant Athletic Trainer, at 507-389-5461.
Minnesota State
University, Mankato
Mankato, MN 56001
1-800-722-0544
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Minnesota State Colleges & Universities system and an affirmative action/equal opportunity university.
