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Notification of Sporting Injuries

Name:

Contact Number:


Email Address:

Sport:

Date of injury:

Injury location:
Knee
Ankle
Shoulder
Hamstring
Thigh/Quadriceps
Groin
Calf
Achilles
Foot
Hip
Buttocks/Glute
Toe
Upper Back
Lower Back
Shoudlerblade
Chest
Abdomen
Ribs
Elbow
Hand
Wrist
Finger
Arm
Head
Face/Jaw
Mouth/Teeth
Other

Where did your injury happen?
Trinity Training Group Session
Trinity Competitive Game
Trinity Game - Friendly
Gym Session

Severity:
Mild
Moderate
Severe

Current main complaint:
Pain
Instability
Stiffness
Swelling
Weakness

Did you have to withdraw from activity?
Continued with training/game
Had to withdraw from training/game

Method of injury:
Contact
Non-Contact

Brief description of how injury occurred:


Have you had any treatment already?
No treatment
A&E
Team Physician (Physio/Doctor)
Personal Physio
Personal Doctor

Are you covered under your own private health insurance?
Yes
No

The data collected in this form are used for the sole purpose of recording the notification of a sporting injury and are held for this purpose by Trinity Sport.