All incoming freshman and transfer students that will be
participating in intercollegiate athletics at Merrimack College are
required to fill out the following forms; Medical History, Physical
Examination, Proof of Insurance, and Consent for Medical Treatment
prior to the start of athletic competition.
These forms are in addition to the forms required by Health
Services for all incoming students. All forms should be completed
in full and returned to Merrimack College Department of Sports
Medicine 315 Turnpike St. North Andover, MA 01845 or faxed to (978)
837 –5032 by August 1st, 2009. If you would like a hard copy
mailed to you, please call Mandy Nicoles in the Sports Medicine
Department at (978) 837–5248
Returning Athletes are required to submit an updated Medical
History, Proof of Insurance, and Consent for Medical Treatment on
an annual basis. These forms should be mailed or faxed to Merrimack
College Department of Sports Medicine 315 Turnpike St. North
Andover, MA 01845 or (978) 837 – 5032 by August 1st 2009.
Merrimack's
Athletic Training Homepage
Directions for
all forms
Medical
History: is to be completed by the student athlete.
Please explain in detail any question that you have answered yes to
as well as a corresponding date.
Physical
Exam (Freshmen and Transfers): This form is to be
completed by your Primary Care Physician within six months from
your reporting date to campus. You must bring this form with you to
your primary care physician.
Proof
of Insurance:
Please attach a photo copy of your primary insurance card as well
as answering the following questions that accompany the form.
Consent
for Medical Treatment: please review the form, sign
and date.
Claim
Process Form / Excess
Insurance Policy Memo
If you have any questions please feel free to contact Many Nicoles
in the Sports Medicine Department at (978) 837 – 5248
About the Sports Medicine Department:
The newly-reaccredited division of Sports Medicine and Athletic
Training at Merrimack College is designed with a dual purpose. The
department is both a fully-functioning athletic training room that
provides health care services for approximately 300 Warrior
student-athletes participating in 16 varsity intercollegiate sports
and an educational facility which provides a top-notch athletic
training curriculum with an emphasis on allied health
education.
Student-athletes and Merrimack receive the finest medical care
available for the prevention, diagnosis, and treatment of athletics
injuries. Director of Sports Medicine Birgid
Hopkins, Clinical Coordinator of Health
Science Dennis Fontaine and Head Athletic
Trainer Mandy Nicoles supervise the sports
medicine staff which consists of five BOC Certified Athletic
Trainers and approximately 30 athletic training students. The staff
is committed to ensuring quality care for student-athletes while
enabling a safe and healthy participating in intercollegiate
athletics.
In conjunction with the College’
s Hamel Health Center, Ort
hopaedics Northeast P.C., and physical therapist Andy Cannon, the
athletic training department at Merrimack provides on-site first
aid, evaluation and treatment of all athletic injuries, as well as
full rehabilitation therapy.
Dr. Steven Andriola, Dr. Keith Cordischi, Dr. Ronald Marvin, Dr.
Richard Bargar, Dr. Richard Choi, and Jamie Stasko (PA-C) serve as
Merrimack’s team physicians and are readily accessible to
provide optimal care and prevention of all athletic injuries.
Merrimack’s sports medicine program is in its 14th year of
offering a field of study that will allow the athletic training
student a wide variety of academic and clinical programs that will
provide knowledge and skills in accordance with National Athletic
Trainers Association competencies and Commission on Accreditation
of Athletic Training Education Programs guidelines.
Some of Merrimack’s alumni have gone on to assume positions
at University of Tennessee, Florida State University, University of
Maryland, Palmer School of Chiropractic, and many other Allied
Heath Care programs, including physical therapy, physician
assistant, and nurse practioner.