May 27th 1:00-3:00 pm
Charlotte Anne Russell Medical Center
Incoming 6th graders and 9th graders must have a SCHOOL physical and NOT a sports physical.
|Pre-Physical Form||HRHC Sports Physical Registration Form|
On May 27, Carle Hoopeston will offer a sports physical clinic from 1-3 p.m. at Charlotte Anne Russell Medical Center. Physicals will be performed by our providers and will be offered for a fee of $15, to be paid at the time of service.
If you would like for your child to receive a sports physical, you will need to complete the following forms, which are enclosed for your convenience:
- Universal Consent Form – This form gives us permission to see and treat your child. It will need to be completed, signed and dated by the parent/guardian.
- Basic Registration Form - This form gives us basic information about your child, including name, address, date of birth, insurance provider, etc. It will need to be completed, signed and dated by the parent/guardian.
- Sports Physical Form – This form gives us basic health information about your child. There are two sides to the form: one side that will be completed by our providers and another side that will need to be completed by the child and parent/guardian together. Please do not complete the provider side. Complete only the side reserved for the child and parent/guardian. A signature is required at the bottom of this side. Please include both the child’s and the parent/guardian’s signature in this section. This side must be completed and signed prior to arriving for the sports physical.
We ask that your child return all completed forms to us on the day of the sport physical clinic.
We look forward to providing care to your child. For more information about our sports physical clinic, please call Carle Hoopeston Regional Health Center at (217) 283-8500.