Before your child can try out, practice, or compete in any NCHSAA-sanctioned sport, the school needs a completed NCHSAA physical form — officially the Pre-Participation Physical Evaluation, or PPE — on file. The form has three parts: a health history you and your child fill out at home, and a physical exam and medical eligibility decision that a licensed provider completes at the appointment. Once signed by the provider, it stays valid for 395 days.1North Carolina Office of Administrative Hearings. 16 NCAC 06E – Subchapter E Rules
Where to Get the Current Form
Download the PPE from the NCHSAA Health and Safety page at nchsaa.org. The association posts a fresh version each school year, labeled with the upcoming year (for example, “2026–2027 Pre-Participation Physical Evaluation”). An English PDF and a Spanish version are typically both available.2North Carolina High School Athletic Association. Health and Safety Your school’s athletic department or its DragonFly MAX portal may also host the form, but the NCHSAA site is the safest way to confirm you have the current edition. Using an outdated version is a common reason forms get bounced back.
Filling Out the Health History at Home
The first section is the Health History, and both the student and a parent or guardian must complete and sign it before the medical appointment. Not at the clinic. Not after the exam. The provider uses your answers to guide the hands-on portion, so showing up with a blank history wastes the visit.3North Carolina High School Athletic Association. NCHSAA Preparticipation Physical Evaluation Form
General questions cover past hospitalizations, surgeries, and any prior restriction from sports. A medications section asks for every current prescription, over-the-counter drug, and supplement. An allergy section covers drug and environmental allergies. These are straightforward. Be thorough.
The Cardiac Screening Questions
The heart-health block is the most consequential part of the history, because it screens for conditions linked to sudden cardiac arrest. Questions to the student ask whether they have ever passed out or nearly passed out during exercise, felt chest pain or pressure while active, or had a racing or fluttering heartbeat. A family block asks whether any relative died unexpectedly before age 35, whether anyone has been diagnosed with a genetic heart condition such as hypertrophic cardiomyopathy or long QT syndrome, or whether a relative received a pacemaker or implanted defibrillator before age 35.3North Carolina High School Athletic Association. NCHSAA Preparticipation Physical Evaluation Form
If you are unsure about family cardiac history, call older relatives before you sit down with the form. A “yes” answer does not automatically disqualify the student. It tells the provider to look more closely and possibly order an electrocardiogram or other testing.
The Mental Health Screening
The current PPE includes the PHQ-4, a brief questionnaire about anxiety, loss of interest, and depressed mood over the previous two weeks. A score above the threshold prompts the provider to ask follow-up questions or recommend further evaluation.3North Carolina High School Athletic Association. NCHSAA Preparticipation Physical Evaluation Form This section is relatively new to sports physicals and catches some families off guard. Answer honestly; the screening is confidential.
Concussion and Injury History
The form asks about prior concussions, including how many and when the most recent one occurred, plus bone and joint problems, past injuries that required medical attention, and any condition that caused the student to miss practice or competition. If your child has a concussion history, bring documentation of prior diagnoses and clearance dates. Providers weigh repeat concussions heavily.
The Clinical Exam and Eligibility Decision
Bring the signed health history to the appointment. The provider completes the remaining two sections during the visit. The Physical Examination section covers vital signs (pulse, blood pressure, vision), a systems-based check of the heart, lungs, abdomen, skin, and neurological function, and a musculoskeletal evaluation of the neck, back, shoulders, knees, and ankles.3North Carolina High School Athletic Association. NCHSAA Preparticipation Physical Evaluation Form The exam is not a substitute for an annual well-child visit. Its focus is whether the student can safely handle the physical demands of the sport.
After the exam, the provider signs the Medical Eligibility section with one of three determinations: eligible for all sports without restriction, eligible for certain sports only, or not eligible pending further evaluation. Restrictions are binding, and the school will enforce them. The provider’s printed name, license number, and office contact must also appear on the form.3North Carolina High School Athletic Association. NCHSAA Preparticipation Physical Evaluation Form
Who Can Legally Sign the Form
North Carolina administrative code limits the exam to a licensed physician (MD or DO), nurse practitioner, or physician assistant.1North Carolina Office of Administrative Hearings. 16 NCAC 06E – Subchapter E Rules Chiropractors, athletic trainers, and physical therapists cannot perform the initial sports physical, even though some of those professionals can clear a student for return-to-play after a concussion under separate rules. If you take your child to a provider who is not on the approved list, the form will be rejected and you will need a second appointment.
Submitting the Completed Form to Your School
Once the provider returns the signed form, submit it to your school’s athletic department. A growing number of North Carolina schools use DragonFly MAX, an online platform where you create a parent account, link to your child’s school, and upload a scanned or photographed copy of the completed PPE.4Wilkes Central High School. Dragonfly Athletic Registration Upload the completed physical as a document. Do not try to fill out the PPE fields electronically inside the platform, because the system requires the provider’s handwritten entries and signature.
Schools without a digital platform still accept paper copies delivered to the athletic director’s office. Either way, staff review every form to confirm all three sections are complete, all required signatures are present (student, parent, and provider), and no fields are blank. Missing signatures or incomplete sections get sent back. Students cannot attend tryouts, practice, or compete until clearance is confirmed. There is no grace period and no exceptions.2North Carolina High School Athletic Association. Health and Safety
How Long the Form Stays Valid
A completed physical is valid for 395 days from the date the provider performed the exam.1North Carolina Office of Administrative Hearings. 16 NCAC 06E – Subchapter E Rules That roughly 13-month window gives families a cushion to schedule the next physical before the current one expires, so there is no gap between school years. If the physical expires mid-season, the student is immediately ineligible until a new exam is completed and a fresh form is submitted.
The practical move is to schedule the exam in late spring or early summer. A physical done in May covers the following fall, winter, and spring seasons in one shot. Waiting until August for a fall sport cuts the validity shorter and can leave the student scrambling for a new exam before spring playoffs.
When the PPE Alone Is Not Enough
A valid form on file does not mean automatic clearance for the whole season. If a student misses five or more consecutive days of practice because of an injury, the NCHSAA requires a new medical release before returning. That release can come from a licensed physician, nurse practitioner, physician assistant, or licensed athletic trainer. The NCHSAA provides a separate Injury Return to Play form, available on the same Health and Safety page.5North Carolina High School Athletic Association. NCHSAA Injury Return to Play Form A separate Return to Play after Illness form covers extended absences from medical conditions unrelated to injury.2North Carolina High School Athletic Association. Health and Safety
Concussions have their own track under North Carolina’s Gfeller-Waller Concussion Awareness Act. Every year, coaches, athletic directors, school nurses, students, and parents must receive and sign a concussion information sheet, and students and parents must return their signed copies to the coach before any tryout, practice, or game.6North Carolina General Assembly. House Bill 792 – Gfeller-Waller Concussion Awareness Act This sheet is separate from the PPE, not a substitute for it. If a student shows concussion signs during play, the law requires immediate removal and no return that day. Before returning on any later day, the student needs written clearance from a physician, neuropsychologist with concussion training, licensed athletic trainer, physician assistant, nurse practitioner, or, as of 2025, a licensed physical therapist.7North Carolina General Assembly. Session Law 2025-49 A graduated five-stage return-to-play protocol and parent consent are also required before full participation resumes.8North Carolina High School Athletic Association. NCHSAA Concussion Return to Play Protocol Form
What the Exam Costs
Out-of-pocket fees at an urgent care clinic or pediatrician’s office generally run between $25 and $75, depending on the provider and whether the visit is billed as a standalone sports physical or bundled into an annual wellness check. Many insurance plans cover a well-child visit that can double as a sports physical if the provider agrees to complete the PPE during the same appointment. A standalone sports physical ordered solely for athletic clearance is not always covered as preventive care, so call your insurance company and the provider’s office ahead of time to avoid a surprise bill.
Some community health centers and local organizations offer free or reduced-cost sports physicals in the weeks before fall sports registration. Your school’s athletic department or guidance office is the best place to ask about upcoming events in your area.