• Sports Physical Form

    Physical and concussion forms can be found in your school's activities office.  Return the physical and concussion form filled out and signed by your parent or guardian to the activities office at your school. No exam will be allowed unless signed by a parent. 

    These are sports physicals and do NOT take the place of a comprehensive physical. No immunizations will be given.

    The forms must be filled out and turned in before students may participate in athletics. 

    Sports physical form and Iowa Heads Up Concussion Fact Sheet and form 

     

    Iowa Concussion Legislation

    Effective July 1, 2011, Iowa law requires that students in grades 7 – 12 who participate in extracurricular interscholastic activities, cheerleading and dance; and their parents/guardians; must sign a copy of the acknowledgement form found below and return it to their school.

    Students cannot practice or compete in those activities until this form is signed and returned.

    In addition, please note this important information from Iowa Code Section 280.13C, Brain Injury Policies:

    1. A child must be immediately removed from participation (practice or competition) if his/her coach or a contest official observes signs, symptoms, or behaviors consistent with a concussion or brain injury in an extracurricular interscholastic activity.
    2. A child may not participate again until a licensed health care provider trained in the evaluation and management of concussions and other brain injuries has evaluated him/her and the student has received written clearance from that person to return to participation.
    3. Key definitions:
      1. “Licensed health care provider” means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.
      2. “Extracurricular interscholastic activity” means any extracurricular interscholastic activity, contest, or practice, including sports, dance, or cheerleading

     

    Sports Physicals Offered Locally

    Students participating in sport competitions are required to have a physical examination so the student may safely engage in athletic competition. An Iowa Athletic Pre-Participation Physical Examination Form and Concussion Form must be completed and returned to the Activities Office prior to any participation in athletics.

    The following offices will conducted sports physicals for Ankeny and Ankeny Centennial High School students for the 2018-19 school year.  Check back for walk-in physical dates during the summer of 2019.

     

    UnityPoint Family Medicine Clinic - Ankeny Medical Park

    3625 N Ankeny Blvd., Suite F

     

    Naig Chiropractic

    225 SE Oralabor Rd., Suite #7