Practice Medical Form

Contact Details
Legal NameJem Thomson-McAdam
EmailEmail hidden; Javascript is required.
Phone07792230232
TeamWomens Team
Date of Birth22/08/2000
Next of Kin DetailsIn the case of emergency, who is the best person to contact
NameChristine McAdam
RelationParent
Phone07971480458
Travel & Accomodation Details
Travel ArrangementCar (Drove Self)
Medical
Medical ConditionsYes
Condition Details

Borderline Personality Disorder

Pre-existing injuriesNo
Medication(s)Yes
Medication Details

Venlaflaxine
Promethrazine Hydrochloride

(Taken in morning so shouldn’t be an issue)

Ibuprofen & cocodamol when required (I have them with me)

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
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