Athletic event coverage

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You can request help from our sports medicine staff for an upcoming athletic event when you fill out the form below. We will get back to you as soon as we can.

Athletic Event Coverage Request

(For greater Charlotte area)

Event Information:

Name of event

Name of host organization

Event street address

Event city

Event zip code

Event contact

Event contact first name

Event contact last name

Event contact email

Event contact phone number

Arrival time for provider(s)

Number of participants

Age range of participants

Number of playing fields or facilities

Event date(s)

Event time(s)

Billing contact

First name

Last name

Phone number

Street address

City

Zip code

Validation

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Athletic event coverage

Event Information:

Event contact

Billing contact

Locations

Services

Patients