Request an Appointment
Use this form to request an appointment with the VC Sports Medicine Department for injury evaluations, consultations, treatment, or rehabilitation.  Once submitted, the athletic trainer will contact the student-athlete to schedule a date and time.  There is no need for an additional email to the VC Sports Medicine Department following submission of this form.  If there are any issues with submitting the form, please contact the VC Sports Medicine Department at smd@vchsweb.org. 
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Student's Full Legal Name *
Date of Birth *
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Student's Email *
Reason for Appointment *
Date of Injury *
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DD
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YYYY
Body Part Injured *
Required
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