Athletic Training Registration

Participant Information

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address *

Emergency Contact Name *

Emergency Contact Phone *

Location *Barnes TennisLa Jolla Tennis

Medical History

Current Injuries or Pain Areas

Previous Injuries or Surgeries

Medications & Allergies

Medical Disclaimer & Acknowledgment

Important Medical Information

I understand that the athletic trainers and medical staff at Synergy Orthopedic Specialists provide evaluation, treatment, and preventive services only.

Services do not replace physician diagnosis or emergency care
I have disclosed all relevant medical information
I am physically capable of participation
Serious conditions require immediate medical attention

I have read and understand the medical disclaimer above.

I consent to receive athletic training evaluation and treatment.

I assume all risks and release Synergy Orthopedic Specialists from liability.

I acknowledge that my medical information will be handled per HIPAA.

Find a Specialist

Find a Location

Athletic Training Registration