Knight Performance Factory

Today's Date *

Guardian's Full Name (if athlete is a minor)

Guardian's Cell Number (if athlete is a minor)

Guardian's Email (if athlete is a minor) *

Athlete's Full Name *

Athlete's Age *

Gender *

Type of injury *

Date of injury *

Age at time of injury *

Activity at time of injury *

What side of the body? *

If ACL, what was used for repair? *

Was surgery needed? *

Type of surgery *

Date of surgery

Surgeon's Full Name

Surgeon's Practice

What is the name of the group/hospital the surgeon works with?

Physical Therapist's Full Name *

Physical Therapist's Practice *

What is the name of the group/hospital the PT works with?

Start of Physical Therapy *

End of Physical Therapy

First injury? *

First injury to this area? *

Are you a multiple sport athlete? *

If yes, list sports

Ever participated in performance training before *

If yes, had you been training at time of injury

Please tell us a detailed timeline of your injury *

The Restoration Project