NDHSAA Sports Physical Form
If this is an emergency or if you are experiencing any of the following symptoms:
Suicidal thoughts
Chest or upper abdominal pain or pressure
Shortness of breath-unable to walk across the room
Sudden dizziness, weakness, numbness, or tingling (face, arm, leg)
Sudden inability to speak
Sudden confusion, changes in mental status, or loss of consciousness
Sudden trouble seeing in one or both eyes
Seizures
Uncontrolled bleeding
Severe or persistent vomiting or diarrhea
Coughing blood, vomiting blood, or large blood in the stool
Call 911 immediately and DO NOT use Appointment Request.
*Please scroll to the bottom of the page and click continue to be able to fill out the form.
DISCLAIMER: This form is external to Northland Health Centers and they cannot change its contents. By filling it out and submitting it, I give my explicit consent to receive SMS messages from Northland Health Centers as outlined in their Privacy Policy. I understand that after submitting this form, I can opt out of receiving furfure messages at any time by replying “STOP”.