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Get Eastern Connecticut State University Athletic Pre-Participation Evaluation 2015-2024

Complete this form if you are planning to try out or participate in either intercollegiate or club sports. Please answer the questions and sign below BEFORE taking this form to your doctor’s appointment for your physical. Your health care provider must complete the bottom of page 1 and all of page 2 of this form. RETURN FORM TO: Athletic Trainers, Sports Center, Eastern Connecticut State University, 83 Windham St, Willimantic, CT 06226, or Fax to: 860-465-0324. Y=yes, N=no, ?=unsure Y=yes, N=n.

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