1. PPS Registration

REGISTRATION FORM

Past Player Health Screening and Referral Service
In completing this registration form you will be notifying the NRL Medical Coordinator of your interest in participating in the Past Player Health Screening and Referral service.

This service aims to provide past players with access to a comprehensive clinical service which screens, assesses and communicates outcomes on their holistic health and well-being to them, their GP and nominated support person.

We encourage all eligible past players to get in touch via this form.
Are you completing this form on behalf of yourself? (select no if you are filling this on behalf of a past player)

Past Player Information

Past Player Health Screening and Referral Service
In completing the following questions, you help us verify the Past Player details allowing us to confirm who you are plus review and agree to the Terms of Participation of this service.
Salutation
Full Name

First NameLast Name
Preferred Name
Email
example@example.com
Mobile
Please enter a valid phone number.Format: 0000 000 000.
Date of Birth

DayMonthYear
Sex
Home Address
Suburb
State
Postcode
Country
NRL ID (if known)
This is a unique ID assigned to every participant who registers, to locate your NRL ID: log in to profile.mysideline.com.au. This field is optional.
Do you have a GP?
GP First Name
GP Last Name
GP Email
example@example.com
GP Mobile
Please enter a valid phone number.Format: 0000 000 000.
Which NRL/NRLW Club did you LAST play for?
Select ‘Other’ if you played for Jillaroos or Kangaroos
Other - NRL/NRLW Club
What year did you play your LAST game of professional rugby league?
What year did you RETIRE professionally?
How many YEARS did you play professionally?
Games played professionally?
Do you have a nominated support person who will be available as an emergency contact and provided with information on each step of the screening and referral process?
Nominated Support Person Name

First NameLast Name
Nominated Support Person Mobile
Please enter a valid phone number.Format: 0000 000 000.
Nominated Support Person Email
example@example.com
Nominated Support Person Relationship?
Other - Nominated Support Person Relationship
Application Status
By tapping Submit, I agree to the NRL Terms of Use, Privacy Policy and Collection Statement
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Should be Empty:

REGISTRATION FORM

Companion Information

Past Player Information