If you are participating in our high school athletics program, please complete the form below. If you would like to nominate your local high school, click here.

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Muscle Map & Pain Scale

Sport-Z™ Evaluation Form

High School*

Name of Athletic Director or Principal*

Email*

Phone*

Participating Sport (Ex: Football)*

Type of Injury (Ex: Lower Back)*

Treatment Type (P1/30min) or (P2/8hrs)*

Pain Level BEFORE Treatment (0-10)*

Pain Level AFTER Treatment (0-10)*

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