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