Get Usada Therapeutic Use Exemption Application Form

Filling out the USADA Therapeutic Use Exemption Application Form online is a crucial step for athletes who require the use of prohibited substances for medical reasons. This guide provides a thorough, step-by-step approach to ensure you accurately complete the form.

Follow the steps to effectively complete your application.

1. Press the ‘Get Form’ button to obtain the Therapeutic Use Exemption Application Form and open it for editing.
2. Begin by entering your athlete information in the designated fields. This includes your last name, first name, gender, date of birth, mailing address, city, state, zip code, daytime phone number, sport, and email address. Be sure to provide an accurate email, as this will be used for communication related to your application.
3. If you wish to nominate someone to discuss your application with USADA, provide their name and your relationship to them in the specified area.
4. List any upcoming national or international events where you intend to compete, including specific dates and event names.
5. In the Athlete Declaration section, certify your information is accurate and affirm your request for approval to use a prohibited substance. Sign and date the declaration. If you are a minor or unable to sign, ensure a parent or guardian signs on your behalf.
6. Proceed to the Medical Information & Diagnosis section. This section is for your physician to fill out, detailing your diagnosis.
7. In the Supporting Documentation area, your physician must check all relevant supporting documents that should accompany your application. Ensure a comprehensive medical history and relevant clinical notes are included.
8. Input medication details specified by your physician, including the prohibited substance(s), dosage, generic name, route of administration, and frequency. Indicate the intended duration of treatment, selecting the relevant option.
9. Obtain a declaration from your medical practitioner certifying the medical appropriateness of the treatment and documenting that alternatives were unsatisfactory. Ensure they provide their contact information for verification.
10. After completing the form, save your changes, and download or print the application for submission.
11. Submit your completed application to the U.S. Anti-Doping Agency either by mail, fax, or email. Retain a copy for your records and confirm receipt within three business days.

Start filling out the USADA Therapeutic Use Exemption Application Form online today to ensure your medical needs are addressed.