The questionnaire can de downloaded below.

It is recommended that, under the age of 21, the questionnaire should be filled in under the supervision/in conjunction with parent(s)/guardian(s). Anyone answering yes to any of the questions should discuss the findings with their family doctor.
Our suggestion would be that in the context of younger players particularly, team managers and teachers should actively encourage their players to fill in this questionnaire.

Of all the cardiac screening tools, the best predictor of sudden death risk is a positive questionnaire.

There is a lack of scientific consensus on the overall value of further screening.

Those who choose to pursue further screening however should be aware of the following:

• Testing should be done in a centre where ECG’s/ECHO are being reported by experienced sports cardiologists.
• There is a significant percentage that will have an abnormality which may require further evaluation.
• A percentage will end up uncertain as to whether it is safe for them to participate or not.

Please print of a copy of this form

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