Female Athlete Health Screening Form
Please complete this medical intake form to help assess your readiness, risks, and support needs as a female athlete.
Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Contact Email
*
example@example.com
Primary Sport
*
Are you currently experiencing any pain or injury?
*
No
Yes, minor
Yes, significant
Have you had any major injuries or surgeries in the past year?
*
No
Yes, injury
Yes, surgery
Do you have any current medical conditions (e.g., asthma, diabetes, heart condition)?
*
Asthma
Diabetes
Heart condition
None
Other
Are you currently taking any medications or supplements?
*
No
Yes, prescription medication
Yes, over-the-counter medication
Yes, supplements
Do you have any allergies?
*
No allergies
Medication allergies
Food allergies
Environmental allergies
Other
Have you started menstruating?
*
Yes, regular cycles
Yes, irregular cycles
No
How would you describe your current nutrition and hydration habits?
*
Balanced and consistent
Somewhat inconsistent
Needs improvement
How many hours of sleep do you get on average per night?
*
7-9 hours
5-6 hours
Less than 5 hours
How would you rate your current mental health and stress levels?
*
Good, manageable stress
Occasional stress or anxiety
Frequent stress or anxiety
Submit Screening
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