USC Aiken :USCA Athletic Training Visiting Team Athletic Training Services Form

Please provide the following taping and/or treatment indicated below for the visiting athlete presenting this form.

Visiting Team:                                 Sport:

Athlete Name:        Contest Date:

Body Area (Indicate by placing a "y" in the box):

Right     Left     Both    Body Area:

Treatment (Indicate by placing a "y" in the box)    Cold Pack     Cold WP     Ice Cup     Warm WP     Hot Pack

Modalities (Indicate by placing a "y" in the box)       E-Stim        Ultrasound        Combo

Specific Instructions:

Taping Instructions:

Certified Athletic Trainer:

Name:              Phone:

471 University Parkway
Aiken, SC 29803
Phone: 8033.641.3367
Fax: 803.641.3441
Email: brandona@usca.edu