Physical Form

Per IHSAA guidelines, please note:

• The most current version of the IHSAA PPE Form must be used and may not be altered or modified in any manner.
• The PPE form must be signed by a physician (MD or DO), nurse practitioner or physician’s assistant only after the medical history is reviewed, the examination performed, and the PPE Form completed in its entirety. No pre-signed or pre-stamped forms will be accepted.
• The signature must be handwritten. No signature stamps will be accepted.
• The signature and license number must be affixed on page three (3).
• The parent signatures must be affixed on pages two (2) and five (5).
• The student-athlete signature must be affixed on pages two (2) and five (5).

Distribution

• History Form retained by the Healthcare Provider

• Examination Form and Consent and Release Form signed and returned to member school