Open Menu IconClose Menu Icon

Certified Athletic Trainer (ATC) Appointment Request

Rothman Orthopaedic Institute works directly with sports team and athletic trainers around the region to make sure that student, amateur and professional athletes are all given the best and most immediate care possible when an injury occurs while playing, practicing or training.

Certified Athletic Trainers can schedule appointments for their athletes by using our ATC Appointment Form.

Athletic Trainer Name*
Please enter the Trainer's name

Athletic Trainer Email*
Please enter the Trainer's email

Athletic Trainer phone*
Please enter the Trainer's phone

Athlete name
Invalid Input

Athlete Date of Birth
Invalid Input

Athlete Injury
Invalid Input

Parent's name
Invalid Input

Parent's phone number
Invalid Input

Parents' email
Invalid Input

With whom should we follow up?
Invalid Input

School or Team Affiliations
Invalid Input

Insurance
Invalid Input

Is the Athlete a previous patient of Rothman Orthopaedic Institute?
Invalid Input

Requested Physician
Invalid Input

Security Validation
Invalid Input

1 of 1
1 of 1
You are using an unsupported version of Internet Explorer. To ensure security, performance, and full functionality, please upgrade to an up-to-date browser.

Online Scheduling

Schedule your in-person appointment entirely online and in real time. Available for first time and returning patients

Schedule Online Schedule Online