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College of Education

Department of Health & Human Performance

MSAT Injury Clinic Questionnaire

Name *

Age *

Date of Birth *

Email Address (Txstate only) *

Telephone Number *

Texts accepted?

Yes

No

What brings you to the clinic? *

How long have you had this issue? *

Have you done anything for it? *

If you happen to see this, do not fill this field.