MPM PORTAL

Complete all sections. Ensure your Medical Diagnostic Form (MDF) has been prepared before submitting.

A. Personal Details

Full Name

IC / Passport No.

Date of Birth

Gender

Male

Female

Contact Number

Email Address

B. Sport

Sport Discipline

Sport Discipline Name (if not listed)

Event (if applicable)

State / Club

C. Impairment

Type of Impairment

Physical

Visual

Intellectual

Diagnosis (brief description)

Affected Body Part / Condition

D. Documents (Upload)

Medical Report

Accepted: PDF, JPG, PNG, DOC, DOCX — max 10 MB

For Intellectual Impairment, the following additional documents are required:

Wechsler Adult Intelligence Scale / Wechsler Intelligence Scale for Children (WAIS / WISC)

Accepted: PDF, JPG, PNG, DOC, DOCX — max 10 MB

Vineland Adaptive Behavior Scales

Accepted: PDF, JPG, PNG, DOC, DOCX — max 10 MB