PreParticipation Consents

Texas Athletics Tryouts

Sports Medicine Pre-Participation

Medical Consents Packet

15.10.1b
12/18/2018

Information regarding completing online waivers, consents, and releases

As a student-athlete at The University of Texas, you have rights regarding the privacy and confidentiality of your medical records. Texas Athletics, Sports Medicine has policies and procedures in place to safeguard the privacy of your medical records and restrict its use.

You have the right to restrict disclosure of your health information. You have the right to revoke any of your authorizations at any time. If you choose to restrict disclosure or revoke any of your authorizations, you must indicate your intention to do so by contacting your Athletic Trainer. Your Athletic Trainer’s email link is provided below after you select your sport or you may call 512-471-4916.

Your health information will always be regarded as “restricted use data”; authorization does not obligate us to share information. In accordance with the HIPAA Privacy Standards, we will respect the privacy of your health information by releasing only the minimum necessary information to protect your health and safety, and we will take appropriate measures to ensure the confidentiality of your medical records.

NOTE: If you are under 18 years of age, the electronic signature of your parent/legal guardian is required on all forms.

Student-Athlete First Name

First name is required

Student-Athlete Last Name

Last name is required

Student-Athlete Date of Birth

Date of Birth is required

Student-Athlete Email

Email is required

Student-Athlete EID

Parent/Guardian First Name

First name is required

Parent/Guardian Last Name

Last name is required

Parent/Guardian Email

Email is required

Select Sport

I am currently prescribed stimulant medication (Strattera, Ritalin, Adderall, etc).

Yes

Note: A DocuSign envelope will be sent to your prescribing physician for their signature.

Physician First Name

First name is required

Physician Last Name

Last name is required

Physician Email

Email is required

I currently have medical insurance.

Yes

Note: You will not be permitted to participate in tryouts without medical insurance.

I have completed a physical examination in the past 6 months.

Yes

Note: You will not be permitted to participate in tryouts without a recent physical examination.

I currently have a Sickle Cell solubility test result.

Yes

Note: You will not be permitted to participate in tryouts without providing a Sickle Cell solubility test result.

Please contact your ATC with any questions concerning your sports medicine consents and medical information submission.

Team ATC Approver:
Team ATC Approver Email:

Note: Mail with a link to your DocuSign forms will be sent to your email specified above. You'll receive 1 email for the tryout consent and medical history packet. If you are prescribed stimulant medication, you will receive a 2nd email of the ADHD Provider form to sign.

Important!
Wait for the blue loading bar below to finish, then check your email to confirm receipt of a link from DocuSign to your consent forms BEFORE closing this page. Then follow the review documents button in the DocuSign email to complete your consent forms.

Texas Athletics Tryouts

Sports Medicine Pre-Participation

Information regarding completing online waivers, consents, and releases

NOTE: If you are under 18 years of age, the electronic signature of your parent/legal guardian is required on all forms.