top of page

Original on Transparent.png

Home
TSH + Athletic Mentors
TSH Outdoor Lessons
Shop
More

Use tab to navigate through the menu items.

Medical Questionnaire

Please fill out the following form to help us understand your physical condition.

First Name

Email Address

Last Name

Date of Birth

Have you been hospitalized in the last 12 months?

No

Yes

Are you currently suffering from a medical condition, illness, or injury?

No

Yes

If you answered yes to any question, please elaborate

Initials

Today's Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

tayloredskillshockey@gmail.com

©2019 by Taylored Skills Hockey Clinic. Proudly created with Wix.com

bottom of page