IHSA By-law 2.150 requires every member school to keep, for each student who practices or competes in interscholastic athletics, a certificate of physical fitness dated no more than 395 days before any date of participation. The IHSA posts this four-page form, built on the AAP preparticipation evaluation, as an optional way to document it. The medical eligibility page comes first, followed by the history and physical examination.
The student completes and signs the history before the appointment, with a parent if younger than 18. The examining physician, physician assistant or nurse practitioner completes the physical examination form and the medical eligibility form with its shared emergency information, signing both as MD, DO, NP or PA.
Enter the athlete's name and date of birth, then check one: eligible for all sports without restriction, eligible with recommendations for further evaluation or treatment of a stated issue, eligible for certain sports (list them), not eligible pending further evaluation, or not eligible for any sports. Add recommendations. The signed statement confirms no apparent clinical contraindications for the sports outlined, that findings are on file in your office, and that eligibility may be rescinded if new conditions arise.
Below the signature, list allergies, medications, other information relevant in an emergency, and emergency contacts. IHSA places the eligibility page first in its form, and this block sits on that same page, so the emergency details accompany the signed clearance wherever the school files it.
The athlete enters name, date of birth, date of examination and sports, sex assigned at birth and gender identity, then lists past and current medical conditions, surgeries, all prescription and over-the-counter medicines and supplements, and allergies. The form asks for this before the appointment, signed with a parent if the athlete is younger than 18.
Four items ask how often over the last two weeks the athlete felt nervous or on edge, could not stop worrying, had little interest in doing things, or felt down or hopeless, each circled 0 to 3. A sum of 3 or more on either pair of questions is considered positive for screening purposes.
Questions 1 to 3 cover concerns for the provider, past sports restrictions and ongoing issues. Questions 4 to 10 ask about passing out, chest discomfort, racing or irregular beats during exercise, known heart problems, prior heart tests, light-headedness and seizures. Questions 11 to 13 ask about family sudden death before 35, inherited heart conditions such as HCM, long QT or Brugada syndrome, and family pacemakers or defibrillators before 35.
These cover stress fractures and injuries, breathing trouble with exercise, missing organs, groin pain or hernia, recurring rashes including herpes or MRSA, concussion, numbness after a hit, heat illness, sickle cell trait or disease, vision, weight worries, special diets and eating disorders, plus menstrual history questions 29 to 32. Yes answers are explained in the box, and the athlete and parent sign and date.
Physician reminders suggest sensitive questions on stress, mood, home safety, tobacco, alcohol and drugs, steroids and supplements, and prompt review of history questions 4 to 13. Record height, weight, blood pressure, pulse and vision. Mark each item normal or abnormal with findings: appearance with Marfan stigmata, eyes, ears, nose and throat, lymph nodes, heart murmurs standing, supine and with Valsalva, lungs, abdomen, skin and neurological. Consider ECG, echocardiography or cardiology referral for abnormal cardiac findings.
Mark the neck, back, shoulder and arm, elbow and forearm, wrist, hand and fingers, hip and thigh, knee, leg and ankle, and foot and toes, plus the functional tests: double-leg squat, single-leg squat and box drop or step drop. Print your name, date, address and phone, and sign as MD, DO, NP or PA.
Download the current version from the source each time; forms change without notice.
Pre-Participation Physical Examination Form
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A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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By-law 2.150 requires a certificate of physical fitness issued not more than 395 days before any date of participation in practice, a contest or an activity. Because the limit applies to each date, a physical that is valid at the start of a season can expire partway through it if the exam date passes the 395-day mark.
The by-law names a licensed physician, physician assistant or nurse practitioner as set forth in Illinois statutes. IHSA interprets licensed physician as one licensed to practice medicine in all its branches, so a chiropractor's exam qualifies only with that license. The form's signature lines read MD, DO, NP or PA.
Yes. The IHSA Download Center posts a Spanish version of the Pre-Participation Physical Examination Form alongside the English one, both updated in July 2025. Families can complete the history in Spanish while the clinician completes the examination and eligibility pages.
No. The IHSA says it provides the form only as a service and its use is optional. Some form of written physical examination certificate is still required under By-law 2.150, and many districts accept the Illinois Certificate of Child Health Examination, the IDPH school physical form.