Athlete Medical Form HEALTH HISTORY - Special Olympics
EPILEPSY AND/OR SEIZURE HISTORY Epilepsy or any type of seizure disorder No Yes If yes, list seizure type:_____ ... Follow up with a vision specialist Follow up with a hearing specialist Follow up with a dentist or dental hygienist Follow up with a podiatrist Follow up with a physical therapist Follow up with a nutritionist Other/Exam Notes:
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