FORMS - Facilities Use, Physical and Others / St. Luke's Permission Forms & Info

Thank you to St. Luke's

St. Luke's is the provider for Athletic Trainers and Sports Medicine at the Tamaqua Area School District.

Our trainers and information are:

Mike Toth, LAT, ATC
Email: Michael.toth@sluhn.org or
mtoth@tamaquasd.org

Mykalan Mendoza, LAT ATC
Email: mykalan.mendoza@sluhn.org or
mmendoza@tamaquasd.org

Doctors:
Richard Sirard, MD
Sports Medicine

Daniel Cohen, MD
Sports Medicine

Phone: 484-526-1735
Website: sluhn.org/ortho

(Last Modified about a minute ago)

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Consent to Treat Form

st lukes consent to treat form.pdf 69.26 KB (Last Modified on June 7, 2017)

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Impact Testing Consent Form

ImPACT Permission Form Tamaqua.doc 1.14 MB (Last Modified on November 16, 2016)

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HIPAA Privacy Authorization Form

St. Lukes - HIPAA Privacy Authorization form.doc 29.00 KB (Last Modified on November 16, 2016)

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Head Injury Instructions

St. Lukes - Head Injury Instructions.doc 27.50 KB (Last Modified on November 17, 2016)

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Last Modified on March 28, 2022

FORMS - Facilities Use, Physical and Others