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Athletic Training Forms

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Dear Parent:

Welcome, on behalf of the GVSU Athletic Training Staff to another year of Laker Athletics. Please take a few minutes to review the following information, which includes some forms and medical paperwork that need to be downloaded, completed and returned to me. Also, here you can find the GVSU Medical Billing Payment Policies and Procedures, the GVSU Education and Support Program on Drug and Alcohol Abuse/Drug Testing Program, the NCAA List of Banned Substances and the HIPAA Statement for protected health information. Please take some time to read these documents, and feel free to contact me if you have questions. The following is a list of forms you will need to download and return when completed. These need to be sent in by 8/1/08, and failure to do so may result in a student athlete being held out of practice until the forms are complete.

*Medical Insurance Information Form
•If a part of the form does not apply to you (i.e. middle initial), please put a line through the space or write "N/A"
•Attach a front and back copy of your insurance card. If your insurance company does not issue cards, please write "N/A" in the space where the cards should be attached
•If you do not have medical or dental insurance, complete Section 1 (Student Athlete Information) on the form and report "No Coverage" under Section 4 (Medical Policy Information) Barbara Helms should be consulted for alternate insurance options.
•Please don't forget to sign the form
•Pay specific attention to: Medical and Dental Effective Dates, Insurance Limits, and Sport Exclusions
*Dental Insurance Information
*Secondary Insurance Information
*Medical History Form
*HIPAA Form
*Assumption of Risk/Consent to Treat Form
*Drug Testing Consent Form

Please read and understand the Medical Bill Payment Policies and Procedures, and if your child sustains an injury during the year that results in a bill, please refer back to the policy for pertinent information.

Also, each student athlete is required to have a pre-participation physical examination each year, with GVSU Team Physicians. That will be done when they arrive back to campus, and specific dates will be available by contacting either your child's coach or myself.

Thank you for your time and attention to these details. Feel free to contact me at 616.331.3329 or at stoessnm@gvsu.edu if you have any questions.

Sincerely,
Mark A. Stoessner, MA, ATC
Head Athletic Trainer

 
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