MLQ Player Injury Report Form
The following questions pertain only to the injured player's information. Only select questions indicated by (X) will be available to the public for player tracking, but every other response will be used solely for MLQ data analysis.
* Required
(X) Player's Team
*
New York Titans
Boston Night Riders
Washington Admirals
Ottawa Black Bears
Indianapolis Intensity
Cleveland Riff
Detroit Innovators
Rochester Whiteout
(X) Player Name
*
Your answer
Date of Injury
*
MM
/
DD
/
YYYY
Time
:
AM
PM
(X) Primary Player Position
*
Chaser
Beater
Keeper
Seeker
Player Position at Time of Injury
*
Chaser
Beater
Keeper
Seeker
(X) Type of Injury
*
Sprain/Strain
Joint dislocation
Fractured bone
Knee injury
Shin splints
Concussion
Laceration/Abrasion (Cut/scrape)
Other:
Required
Was the information in the question above provided by a medical professional?
*
Yes
No
Was the injury due to an illegal play?
*
Yes
No
N/A
Injury Narrative
*
Please describe the events that caused the injury to occur.
Your answer
Response to Injury
*
Were emergency personnel contacted? Was the player taken out of play? Did the player return to play? etc.
Your answer
Additional Medical Professional Information
*
Players are strongly encouraged see a doctor/specialist after injury, please state their advice or diagnosis. If a medical professional has not been contacted, state "none" below.
Your answer
(X) Estimated Date of Return to Practice
*
MM
/
DD
/
YYYY
(X) Estimated Date of Return to Game
*
MM
/
DD
/
YYYY
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