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Sports Physical Forms

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The Orthopaedic Center of Southern Illinois has typically conducted a MVTHS Sports Physical night in May as an affordable way to get a sports physical AND create a fundraiser for your child's sport. Unfortunately, we had to cancel this year due to COVID-19. We are now offering a new opportunity that continues our commitment to our students/athletes and sports programs at MTVHS.

During the months of June, July and August, you can make an appointment (618-242-3778 option 3) for a sports physical and pay only $10. The $10 fee for physicals will be donated back to the sport of your choice at MVTHS. Please specify which sport you would like your child's fee to go to on the attached permission form.

If you are unable to attend the physical with your child, the attached permission slip must be signed by the student's parent/guardian and the HISTORY portion of the PPE (pre-participation physical evaluation) must also be completed, as well as signed by the parent/guardian AND student, before the physical can be done. If you do not have access to a printer, we will have extra forms available when you bring your student to the appointment. 

OCSI will NOT be writing any prescriptions, updating immunizations or treating any specific medical problems. This will strictly be a screening physical for participation in sports. It is state law that any student who wishes to participate in any school sponsored athletic team or squad, must first have a current physical (within 365 days of the first day of the activity). 

RECAP:

1.  Call and make a sports physical appointment at OCSI: (618) 242-3778 Option 3

2.  Print and fill out Permission Form and PPE (physical form) if not attending the appointment with student

3.  Pay $10 (cash or check) and designate which sport receives the donation

Be advised:  OCSI does $10 physicals by appointment for ALL area students; however, the $10 donation back to their sport is limited to MVTHS athletes that have a physical done during June, July and August. 

Permission Slip for Physical

Pre-participation Exam - form 1

Pre-participation Exam - form 2

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Request Appointment

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Meet Our Providers

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About Us

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