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Sports Medicine Department
Main Phone Number: 781.891.2940
Location
The Bentley University Athletic Training Room is located on the first floor of the Dana Athletic Center on the lower campus.
Staff
Brooks Farry, MS, ATC
Head Athletic Trainer
781.891.2062
Main responsibilities: Football, Men's Basketball, Baseball
bfarry@bentley.edu
Elizabeth Kasa, MS, ATC
Athletic Trainer
781.891.2060
Main responsibilities: Women's Soccer, Field Hockey, Women's
Basketball, Softball
ekasa@bentley.edu
Charlie Carkin, ATC, CSCS
Athletic Trainer/Strength and Conditioning Coach
781.891.2063
Main responsibilities: Men's Soccer, Ice Hockey, Men's Lacrosse
ccarkin@bentley.edu
Adrian Wright-FitzGerald, MS, ATC
Athletic Trainer
781.891.2493
Main responsibilities Volleyball, Men's and Women's Swimming,
Women's Lacrosse
afitzgerald@bentley.edu
Team Physicians
Dr. Albert Franchi
Orthopedic Physician
781.979.2511
Dr. James DeVellis
Orthopedic Surgeon
781.782.1310
Emergency Numbers
Bentley University Student Health Services: 781.891.2222
Newton-Wellesley Hospital: 617.243.6000
Bentley University Police (Emergency): 781.891.3131
Bentley University (Non-Emergency): 781.891.2201
Forms
All student athletes are required to turn in Bentley University Medical History and Orthopedic Physical Exam Form, as well as The Pre-participation Physical Evaluation form prior to any participation in any intercollegiate sports. These forms are different than the Health Services Physical Form. To access these forms, click on the download tabs below. Print these forms and fill them out. If you would like a paper copy of the forms mailed to you, please call us at 781-891-2940, leave your name, address and phone number. We will then mail you the forms and contact you to let you know they have been sent.
Below you will find detailed instructions on how to fill out each form. Once these (2) forms are filled out completely you are to mail them back to us (Athletic Training Dept., Bentley University, 175 Forest Street, Waltham, Mass. 02452-4705) no later than July 31. If you have any questions regarding either form, please feel free to contact a member of the Athletic Training Department at 781-891-2062. If there is no answer, please leave a message and we will return your call.
The Bentley University Medical History and Orthopedic Physical Exam
Download (PDF, 284k)
Orthopedic Exam: This page will be completed on the day of your on campus orthopedic exam. Please fill in your name and sport, then leave the rest blank.
Medical Questionnaire: Please fill out these pages completely, making sure you answer all of the questions. When asked to explain certain items or provide a date, please do so. Also, please explain all yes answers being as specific as possible.
Athletic Program Liability Release and Waiver: Please read this page carefully and sign and date the bottom. If you are under 18 years old you must have your parent/guardian sign and date the page.
Consent for Medical Treatment for Minors/Team Physician Clearance/ Authorization For Release of Medical/Personal Information: Please read each section carefully. Print your name, signature and date in each section. Again, if you are under 18 years of age, you must have your parent sign and date each section.
Athlete Information Form: Please fill in all sections. If you do not know your school address or phone number leave blank and we will obtain this information at a later date. It is extremely important that you fill in the Health Insurance Information completely. If you have insurance through Bentley University and this is the only insurance you have, make sure you check the box and the school will provide us with the rest of the information.
Pre-participation Physical Evaluation Form
(physical exam must be within 6 months of when you enter school)
Download (PDF, 122k)
Please fill out the first page completely. Then, you must take the form to your primary care physician and have them fill out the second page. The examining physician is the only one to fill out the second page.
As stated earlier, if you have any questions regarding these (2) forms please contact the Bentley University Athletic Training Staff at 781-891-2062.
