Preparticipation Physical Evaluation Form

Tennessee Orthopaedic Alliance and physicians/staff from Middle Tennessee Medical Center will again offer free pre-participation exams for prospective Rutherford County middle and high school student athletes on Saturday, April 25, 2020. To make this day go as smooth as possible, please note the following:

Exams will be at TOA, 1800 Medical Center Parkway, in Murfreesboro, not at each individual school.

Please have the correct form and all required parent/guardian signatures filled out at the time of arrival. Athletes without completed and signed forms will not be eligible to receive an exam. DragonFly Max is currently updating their website to include the 2020-2021 TSSAA physical form. Once the site is updated, your coach will receive information on how to create a DragonflyMax account for your athlete. The instructional information will also be on the TOA website, www.TOA.com. Once you have completed the forms on DragonFly Max, please print off the history, consent for athletic participation and medical care, and blank physical form. Printers will not be available the day of physicals.

This will be the only opportunity for athletes to receive these exams – no make-up will be done.

Athletes are not required to attend these exams, but a physical is required for participation in sports.

Please avoid any caffeine/energy drinks. Blood pressure will be taken and athlete may not be cleared.

Athletes should dress in shorts/t-shirts to allow physicians to evaluate extremities as needed.

Contact information is listed below. Please do not contact TOA with questions about exams.

Parents are welcome to accompany their children throughout the entire process.

Exams will be complimentary; however, donations will be accepted. Proceeds will be used to purchase medical equipment used by the Rutherford County Athletic Trainers.

Please note that some medical problems detected during physical exam may require clearance from the athlete’s physician. Parents may wish to schedule a complete physical evaluation from their physician.

This is a screening exam for participation in athletics. A more detailed exam can be obtained by your primary care physician.

This exam is not intended to replace a complete wellness physical from your primary care physician.

Each student is responsible for delivery of forms to their coach – copies will not be available.

Please adhere to the scheduled times for your school listed below. A 30-60 min wait should be expected.

7:45AM Smyrna High, Siegel High, Riverdale High, Siegel Middle, Smyrna Middle, Rockvale Middle, Christiana Middle, Whitworth-Buchannan, Rockvale High School
8:30AM Oakland High, Blackman High, MTCS, Oakland Middle, Blackman Middle, Lancaster Christian, Thurman Francis, Eagleville, Rocky Fork Middle
9:15AM LaVergne High, Stewarts Creek High, Holloway, Rock Springs Middle, LaVergne Middle, Central Magnet, Providence Christian, Stewarts Creek Middle, FRCS

Please contact Tamara Mitchell at mitchelltm@TOA.com as soon as possible should there be any conflicts with scheduled times. Do not hesitate to email with problems, questions, or concerns.

Preparticipation Physical Evaluation Form

Preparticipation Physical Evaluation Form

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