— INJURY COMEBACK / INTAKE

LATE-STAGE
RETURN-TO-PLAY.

For athletes coming back from a major injury. Fill this out so we can build a comeback plan around your sport, your timeline, and what your body can handle right now.

← BACK TO SITE

— 01

BASIC INFORMATION

CLIENT NAME *

EMAIL *

PHONE

AGE

POSITION

SPORT(S)

PARENT / GUARDIAN CONTACT (IF UNDER 18)

— 02

INJURY HISTORY & REHAB STATUS

WHAT INJURY ARE YOU RETURNING FROM? *

TYPE

WHEN DID THE INJURY OCCUR? (MM/YYYY)

SURGERY DATE (IF APPLICABLE)

HAS YOUR MEDICAL PROVIDER CLEARED YOU FOR UNRESTRICTED TRAINING?

IF NO, WHAT RESTRICTIONS ARE STILL IN PLACE?

ARE YOU CURRENTLY WORKING WITH A PT / ATHLETIC TRAINER?

IF YES, NAME / CLINIC

— 03

CONFIDENCE & MOVEMENT READINESS

PAIN-FREE DURING DAILY MOVEMENT?

PAIN-FREE DURING STRENGTH EXERCISES?

PAIN-FREE DURING SPRINTING / JUMPING?

CONFIDENCE IN INJURED AREA (1–10)

HESITATION DURING SPRINTING / JUMPING?

HESITATION DURING LIFTING (SQUATS / DEADLIFTS)?

ANY HESITATION, INSTABILITY, OR MENTAL BLOCKS? EXPLAIN

— 04

PERFORMANCE GOALS

TOP 3 GOALS FOR THE NEXT 8–12 WEEKS

TARGET RETURN DATE OR COMPETITION SEASON

SPECIFIC PERFORMANCE METRICS YOU'RE FOCUSED ON

FOCUS AREAS

— 05

TRAINING SETUP & EQUIPMENT

HOW WILL YOU BE TRAINING?

EQUIPMENT YOU HAVE REGULAR ACCESS TO

DAYS PER WEEK YOU CAN TRAIN

PREFERRED TRAINING SCHEDULE

— 06

FINAL STEP

ANYTHING ELSE YOUR COACH SHOULD KNOW?