Sports Team Mid-season Health Check-in Form
Please complete this form to help us monitor and support your health and well-being during the season.
Player Full Name
*
First Name
Last Name
Team Name
*
Player Position
*
Please Select
Forward
Midfielder
Defender
Goalkeeper
Other
Contact Email Address
*
example@example.com
How would you rate your overall physical health at this point in the season?
*
1
2
3
4
5
Have you experienced any injuries or pain since the start of the season?
*
Yes
No
If yes, please describe the injury or pain (location, severity, treatment received):
Please indicate if you have experienced any of the following symptoms in the past two weeks:
*
Fever or chills
Cough or sore throat
Shortness of breath
Muscle or joint pain
Headache
Stomach issues
None of the above
Mental Wellness Self-Assessment
*
Rows
Never
Rarely
Sometimes
Often
Always
Feeling stressed or anxious
1
2
3
4
5
Difficulty focusing during training or games
6
7
8
9
10
Feeling motivated and positive
11
12
13
14
15
Quality of relationships with teammates
16
17
18
19
20
How would you rate your nutrition and hydration habits this season?
*
1
2
3
4
5
How many hours do you typically sleep per night?
*
Please Select
Less than 5 hours
5-6 hours
6-7 hours
7-8 hours
More than 8 hours
Is there anything else you would like to share regarding your health or well-being?
Player Signature
*
Submit Check-in
Submit Check-in
Should be Empty: