Seattle Prep ATR Appointment Request
Fill out the form below if you need to schedule an appointment with Travis, the athletic trainer.
Full Name
*
First Name
Last Name
Grade
*
9th
10th
11th
12th
What is your Seattle Prep email address?
*
example@example.com
Current Sport (Please select all that apply)
*
Baseball
Basketball - Boys'
Basketball - Girls'
Bowling - Girls'
Crew
Cross Country - Boys
Cross Country - Girls
Football
Golf
Lacrosse - Boys'
Lacrosse - Girls'
Soccer - Boys'
Soccer - Girls'
Softball
Swim & Dive - Girls'
Swim & Dive - Boys'
Tennis
Track & Field
Volleyball
Not currently participating in a Prep sport
Other
Please select the reason you're scheduling an appointment with the athletic trainer:
*
New Injury Evaluation
Injury Check-in
Possible Concussion
Concussion Check-in
New Illness
Wound Care
Other
What body part is injured? (ex. Knee, shoulder, head, etc.)
*
What side is injured?
*
Right
Left
Both
N/A
Have you injured this area before?
*
Yes
No
When did this injury happen?
*
How did this injury happen?
*
Please describe your pain:
*
Tingling
Dull
Sharp
Numbness
Burning
Radiating
Ache
Other
Does anything increase your pain?
*
Does anything decrease your pain?
*
Since your injury occurred has the pain:
*
Improved
Stayed the same
Worsened
Any additional comments or information that is helpful to know:
Please select the day and time you'd like to see Travis for an appointment. Note that you cannot schedule an appointment during class time:
*
Submit
Should be Empty: