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Injury Report
Initial injury report to be completed within 12 - 24 hours of injury. Do not attach doctor appointment note.
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* Indicates required question
Name (Coach or Parent)
*
Your answer
Name - injured athlete
*
Your answer
Today's date
*
MM
/
DD
/
YYYY
Date of injury
*
MM
/
DD
/
YYYY
Person making report - Email address
*
Your answer
Location or event on which injury occurred
*
Your answer
Description of injury or problem
*
Your answer
Projected doctor visit date
*
MM
/
DD
/
YYYY
Medical diagnosis (if available)
Your answer
Additional treatment plans (if applicable)
*
Your answer
Dates gymnast will be out of practice
*
Your answer
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