Services

Request a Concussion Screening or Appointment

Please use the form below to request a concussion screening or appointment at McFarland Sports Medicine. We recommend an appointment no later than five days post-injury. Submissions will be answered as soon as possible during regular business hours Monday through Friday.

Please note: We see concussed athletes ages 10 to 25. If you or someone you know has sustained a concussion and are outside of this age range, please see McFarland Clinic's Need Care Now page for options to be seen as soon as possible at one of our clinics.

IMPORTANT: If you or someone you know has sustained a concussion and is experiencing severe symptoms, please call 911 or go to the nearest emergency room immediately.

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Your Name:

Patient's Name:

If you are the patient, please enter your name again.

Contact Phone Number:

Please enter a phone number where we can reach you directly. (We cannot e-mail you back.)

Extension (if applicable):

E-mail:

Please provide if you would like an e-mail confirmation that we received your form.

Birthdate of Patient:

Are you requesting Baseline Testing or Injury Screening?:

Baseline Testing

Injury Screening

Club or School Affiliation:

If none please type "none".

Questions/Comments:

Please provide any additional information or questions you may have.

Approval:

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Services

Request a Concussion Screening or Appointment

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