I'm a Physician Who Signs Sports Physicals Online. Here's Exactly What I Review Before I Sign

If you're a parent considering an online sports physical, you should be asking one question before anything else: does a real doctor actually look at my child's information — or does a website just print a signature?

That's the right question. So let me answer it the way I'd want it answered for my own kid — specifically, and in order. I'm Adam Kawalek, a board-certified internal medicine physician: Brown University, then medical school at the Icahn School of Medicine at Mount Sinai, with more than fifteen years of clinical experience since. I'm licensed in 29 states, and you can look me up in about ten seconds — my NPI is 1326223306. Every SportSlip clearance is personally reviewed by me. Not AI, not a template, not a midlevel signing in my name. Me.

Here is exactly what happens between the moment you submit your child's screening and the moment my signature lands on your school's form.

First: seven questions before you've paid a cent

Before SportSlip takes payment, every family answers seven safety questions. These aren't decoration — they're the highest-yield questions in sports medicine. Has your child ever fainted or nearly fainted during exercise? Chest pain with exertion? Has anyone in the family died suddenly before fifty, or had an unexplained drowning or fainting episode? Is there a doctor-imposed restriction right now? A mention of Marfan syndrome? An uncleared concussion? A surgery they haven't recovered from?

A yes on any of these stops the process before you pay, and we tell you why. If your child needs a cardiologist before they need a clearance letter, selling you a clearance would be the opposite of medicine.

The cardiac history — all 14 AHA elements, not a subset

The American Heart Association publishes a 14-element cardiovascular screening history: personal symptoms, family history, and known cardiac conditions. It is the standard of care for preparticipation screening — and it's the part most rushed physicals shortchange. Our intake is built so all fourteen elements are asked and answered; the software won't let a screen come to me incomplete.

When I review a submission, this is where I start. Exertional chest pain, fainting during exercise, and a family history of early sudden death are the three findings I will never sign past without a closer look.

The injury and concussion history — the AAP's playbook

Next, the musculoskeletal and neurologic history, structured on the American Academy of Pediatrics' PPE monograph, 5th edition — the same preparticipation framework pediatricians use nationwide. Prior injuries. Joint problems. Stress fractures. And concussion history in detail: how many, how recent, and whether return-to-play was ever formally cleared. An athlete with an unresolved concussion does not get a signature from me. Full stop.

The history most seven-minute physicals never reach

The intake also screens what the American Medical Society for Sports Medicine recommends and almost no walk-in visit has time for: sleep, mood, eating patterns, and — for female athletes — the energy-availability and menstrual-history questions that flag RED-S and the Female Athlete Triad. Plus the unglamorous essentials: current medications, allergies, asthma control, diabetes, seizure history, sickle cell status, heat illness, and immunization records. None of this is exotic. It's just thorough — and thoroughness is the entire point of a preparticipation exam.

Vitals, with a source I can trust

Parents submit height, weight, blood pressure, and resting heart rate, and they tell us where the numbers came from — pediatrician records, a pharmacy kiosk, a home cuff. If a value looks implausible, we ask for a re-measure. If a value looks real and abnormal, that's a flag, and flags get my full attention rather than a signature.

The movement video — my eyes on your kid

This is the part that surprises people. Every screening includes a short guided video — about 45 seconds, filmed on a phone: your child standing tall facing the camera, arms spread wide like an airplane, a walk across the room and back, a slow bend to touch their toes, and a few seconds balancing on each leg. It's simple on purpose — any parent can film it on the first try. I'm watching how an athlete carries themselves: proportions (that arms-wide shot is an arm-span check), gait, the spine in forward flexion, balance, and symmetry. And when the standard clip raises a question, I don't guess — I ask that family for specific extra footage, case by case: thumb and wrist signs if I'm thinking about Marfan syndrome, a box drop jump if a knee concerns me, tandem stance and eye tracking when I want a concussion-relevant baseline. Is video the same as my hands on a knee? No, and I'll say more about that below. But it shows me more about how an athlete actually moves than a crowded exam room usually does.

Your school's actual form — not a generic letter

When everything above is clean, I complete and sign the form your school, camp, or league handed you — the one with their letterhead and their checkboxes — along with a signed clearance letter carrying my name, license, and NPI. Institutions can confirm it's real through the verification page on this site. A generic letter your camp has never seen is the hallmark of a rubber-stamp operation; the form is the job.

The three ways a screen can end

• Clear. No flags. I sign, and the clearance is valid for 12 months.
• Review. Something needs a closer look. I go through the entire screen personally, sometimes request records or a follow-up answer from you, and then decide.
• Refer. The findings warrant a real cardiology or orthopedic workup. You get a referral letter explaining exactly what I saw and who should see your child — and a refund. No clearance, no charge, no games.

That third category is the one that should matter most to you when choosing any screening service. A sports physical that can't say no is not a medical evaluation — it's a receipt.

What an online sports physical can't do — honestly

I can't put a stethoscope on your child through a screen, and I won't pretend otherwise. What the published evidence shows is that most disqualifying risk is surfaced by a properly taken history — which is precisely why the AHA's screen is a history protocol, and why a rushed walk-in exam, stethoscope and all, misses what it never asks about. Where hands-on evaluation is genuinely indicated — a murmur history, an unresolved injury — my answer is a referral, not a workaround. For families who want rhythm-level cardiac screening, we also offer an optional ECG reviewed under international criteria.

SportSlip is not a substitute for your pediatrician or an established primary-care relationship. It's a rigorous version of a specific, bounded task: the preparticipation screen.

How to vet any online sports physical — including mine

Five checks, two minutes:

• A named physician. Not "our medical team." A person, with a face.
• A verifiable NPI. Look them up in the NPPES registry. Mine is above.
• Licensure in your state. I'm licensed in 29 states; we won't take your money in the other 21.
• They complete your actual form — not a generic PDF your camp has never seen.
• A way for your school to verify the clearance independently.

If a service fails any of these, walk away — including from us. If it passes all five, then an online sports physical isn't a shortcut around medicine. It's medicine, done where your family actually lives. That's the standard I sign my name to.