Report a Concussion
Use this form to report a concussion to the VC Sports Medicine Department.  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 *
Date of Injury *
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Parent/Guardian Contact Information *
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