2018-19 D'Youville Student-Athlete Medical Forms


D'Youville student-athletes are required to provide annual medical physicals and insurance information that includes coverage for athletically-related injuries. This is a pre-requisite for practice and competition. No student will be allowed to participate, in any way, until such evidence of current insurance coverage and medical information is on file with the D'Youville College Department of Athletics.

The medical form packets for the 2018-17 athletic medical forms are linked below. The packet need to be reviewed and completed along with a clear photocopy of both sides of a current insurance card before a student can be allowed to participate.

2018-19 Incoming Student-Athlete Medical Forms

This applies to ALL incoming student-athletes. (Freshmen, transfers, and student-athletes that did not participated on a D’Youville College varsity athletic team within the last year)

2018-19 Returning Student-Athlete Medical Forms

This applies to ALL returning student-athletes.


The NCAA's Catastrophic Injury Insurance Program covers student-athletes who are catastrophically injured while participating in a covered intercollegiate athletic activity (subject to all policy terms and conditions). This coverage does not qualify as the basic coverage required for participation in athletics at D'Youville College. More information on this program can be found at by following this link to the NCAA website.

Please submit (by mail or fax) your completed medical forms along with a copy of both sides of your current insurance card to the D'Youville College Head Athletic Trainer by Wednesday, August 1, 2018.


Please mail or fax all forms to:

Kevin Pullyblank

Head Athletic Trainer

329 Porter Ave

Buffalo, NY 14201


Fax Number: (716) 829-8272 (D’Youville athletic training room)

If you have any questions regarding this requirement please contact Kevin Pullyblank, Head Athletic Trainer at pullyblk@dyc.edu.

Please make sure you are sending these medical forms to the athletic trainer and not the college’s health care center.