MEDICAL & RETURN TO PLAY FORM
Player: Date:
Diagnosis (if known):
Current Training Status
Modified Reduced Duration Reduced Intensity No training
Comments re training modifications :
Player is able to perform the following training tasks with the team (tick all relevant)
Low Level Warm Up Passing Non-contact ball work Technical skills/drills
Controlled, Lower
Intensity Jogging Possession Drills such
Tactical Session Other:
% Max Speed = ________ Duration = as Rondos
Moderate Level Contact skills drills/ Restricted participation
Small size possession Change of Direction drills
ball work in possession game
Low level chaos, moder- (1v1, 2v2)
ate intensity
Team Acceleration Other:
Contact Tactical Session
% Max Speed = ________ drills/activity
Medium size possession Transition games
High Level Crossing Large size games (8v8)
(4v4,6v6) / drills
High chaos, high intensity
Conditioning drills/ Other:
% Max Speed = ________ Shooting Match conditions
games under fatigue
High-speed Maximum velocity Individual Rehab
Strength Exercies
running drills running Program
Training additions
Other:
Target % of Maximum Speed/Velocity in Session:
Relevant for Session:
Session 1 Session 2 Session 3 Match
Other Rehabilitation to Continue:
Physio Gym Massage Medical Other
Possible Return to Full Training:
Possible Return to Match Participation:
Practitioner Name: Role:
