Practice Medical Form

Contact Details
Legal NameIan Fryer
EmailEmail hidden; Javascript is required.
Phone07958650505
TeamMasters Team
Date of Birth11/10/1973
Next of Kin DetailsIn the case of emergency, who is the best person to contact
NameWendy Fryer
RelationParent
Phone07538906267
Travel & Accomodation Details
Travel ArrangementCar (Drove Self)
Hotel / Accomodation NameAcorn Hotel, 140 Elderslie Street, G3 7AW
Others StayingNone
Medical
Medical ConditionsNo
Pre-existing injuriesYes
Injury Details

Right knee a little weak, back a bit old and has various pain points but good right now

Medication(s)Yes
Medication Details

Citalopram taken daily

AllerigiesNo
CommentsAre there any other items that you believe the Coaches/Organisations should be made aware of?
Agreements
Authority reporting Approval
  • agreed
Insurance Coverage
  • agreed
Medical Release
  • agreed
Sealand Seahawks

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