Deborah L. Ungerleider, MD, LLC
Deborah L. Ungerleider, MD, LLC

High School and Middle School Sports Forms

Please be aware that there is a New Jersey high school sports form that all high schools/ towns are required to use as of April 2010 (updated from 2008 form). The form is also used for middle school sports. The form includes a comprehensive medical history section (Part A), which must be filled out by the parent and student prior to bringing the form here. The physician is required to sign that they have reviewed the history. Therefore we cannot complete forms that do not have this history completed.  We will do our best to complete these forms in a timely fashion. Please keep this in mind as the busy sports physical season approaches.  Due to the increased physician time and liability, the charge for form completion will be $25.

 

If you do not receive this form from the school, you may download it, print it and bring it in to our office. If you wish to do this, follow this link:



 

New High School Sports Form

 

Then click on:

 Annual Athletic Pre-Participation Physical Examination Form



Where to Find Us:

Deborah L. Ungerleider, MD, LLC

44 Godwin Ave Suite 100

Midland Park, NJ 07432

 

(201) 444-8389

 

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© Deborah L. Ungerleider, MD, LLC