Full Exam Form

AKP Full Contact Exam Form

This form is to be filled out by all fighters and given to the event doctor for sign-off. If form is not completed and signed off by the event doctor, you cannot compete in this event.
  • If you choose other below, please inform the Physician that you chose other and why as it may affect your participation in this event.
  • If you answer yes to the question below...please advise the physician so that information can be noted on this form.
  • If you answer yes to the question below...please advise the physician so that information can be noted on this form.
  • Asthma, Blood in Urine, Allergies, Fainting Spells,Rupture (Hernia), Chest Pains, Diabetes, Convulsion, Abnormal Bleeding, Shortness of Breath, Swollen Joints, Frequent Headaches, Chronic Cough, Any Type of Hemorrhage...Anywhere?, Have you had any type of serious head injury- Please choose yes or no below if any of the items above relates to you
  • STOP: Only a Medical Doctor is to complete the information below. Any attempt for anyone else to fill out this form will be deem fraudulent.
  • MM slash DD slash YYYY