Sports Physical Forms

Printable Sports Physical Information Sheet

Please download, fill out, and bring all three of the forms below
to your Sports Physical Appointment.

1) IHS Health Examination & Consent Form

Click to follow the link above. 
Download/print the form and bring it with you to your appointment.

2) Immunization Information Form

Click to follow the link above. 
Download/print the form and bring it with you to your appointment.

3) Authorization for Release – Health Info Athletes

Click to follow the link above. 
Download/print the form and bring it with you to your appointment.

Financial Aid Forms

Financial Aid Forms And Information

Click to follow the link above. 
Download/print the form and bring it with you to your appointment.

Medical Records Release Of Information Request Form

Medical Records Form

Click to follow the link above. 
Download/print the form and bring it with you to your appointment.

You may also print the form and then email it prior to your visit:  SMH_CVH_ROI@kh.org

St. Mary’s Health & Clearwater Valley Health make it easy to obtain copies of your medical records, in paper or electronic formats (for example on compact disc, jump drive or as an email attachment).   A request for your records can be made by completing this authorization form located on our website and returning it by:

Mail to:

  • SMH: 701 Lewiston Street Cottonwood, ID  83522
  • CVH: 301 Cedar Orofino, ID  83544    

Facsimile to:

  • SMH: (208) 962-2313
  • CVH: (208) 476-5385

Electronic mail requests:

You can email the completed form to SMH_CVH_ROI@kh.org .

** In order to ensure the privacy of your information, SMH & CVH always will verify your identify before releasing your information.

Your records may be sent directly to a health care provider of your choice. Your records may be picked up in person, or may be sent by regular mail or electronic mail.  Please note that file size may prevent records being provided by email.

Direct access through patient portal:

For easy, direct access to your medical record, you may access your electronic health information through patient portals that correspond to the electronic medical record platforms used at SMH & CVH.  More information about using a patient portal can be found here.

If you have questions about amending your medical records, restricting access to your records or expressing a concern about you records, please contact Medical Records: Save

  • SMH: (208) 962-3251
  • CVH: (208) 476-4555

IHDE

You can learn more about the Idaho Health Data Exchange here.

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