Appointment Request for Spring 2022

UREC Sports Injury Clinic Appointment Request for Spring 2023

The Sports Injury Clinic is open for appointments Sunday-Thursday 3:00-7:00PM. Appointments requested on the day of must be made by 2:00PM.
UPCOMING CLOSURES:
- Wednesday, March 15
- Sunday, March 19 - Sunday, March 26
First and Last Name:*

First NameLast Name
Pronouns:
Email Address (UofA if applicable):*
example@uark.edu
Date of Appointment (Sunday-Thursday):*

MonthDayYear
Date
Type of Appointment:*

Evaluation (If you have not been to the Sports Injury Clinic for this issue or told by the athletic trainer to return for a follow-up evaluation)Treatment (If you have been to the Sports Injury Clinic for this issue and the athletic trainer recommended treatment)Rehabilitation (If you have been to the Sports Injury Clinic for this issue and the athletic trainer recommended rehabilitation)
Preferred Appointment Time (Select at least 3 options):*

3:00PM3:30PM4:00PM4:30PM5:00PM5:30PM6:00PM6:30PM
Additional information you would like to share:
Example: preferred time of appointment from those chosen above, reminder of previous communication with athletic trainer, general notes about your injury. Information contained in this transmission may contain privileged and confidential information, including patient information protected by federal and state laws. As this is not an encrypted form, please be cautious if including patient health information.
By submitting this form, you agree to the following:
1. Patients are given a 15-minute grace period to arrive at their scheduled appointment. Once that 15-minute period passes, their appointment is canceled, and they must schedule a new one or can do a walk-in appointment depending on the schedule at the time of walk-in.
2. If a non-established patient does not cancel their appointment by 1:00PM on the day of the appointment and/or does not come to the appointment three times in a semester, that patient will only be allowed walk-in appointments for the remainder of the semester.
3. If an established patient with pre-set reoccurring appointments does not cancel their appointment by 1:00PM on the day of the appointment and/or does not come to the appointment three times in a semester, all reoccurring appointments for that time will be canceled and the patient will be responsible for requesting each appointment.
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UREC Sports Injury Clinic Appointment Request for Spring 2023