Declaration of Use Form

A Declaration of Use is limited to the use of:
 
  • Salbutamol and Salmeterol by inhalation (used for asthma)
  • Glucocorticoids by inhalation (used for asthma)
  • Glucocorticoids administered by localised injection
  • Platelet-derived preparations (e.g. platelet rich plasma, ‘blood spinning’) by non-intramuscular routes

Athletes are reminded that a TUE is still required for:
 

  • All beta-2 agonist use except for inhaled Salbutamol and Salmeterol
  • Glucocorticosteroids administered by oral, intravenous, intramuscular or rectal routes.

NOTE: If more than one indication is required a separate declaration must be made for each indication.
 

Please complete all of the following steps in order to declare the use of one of the listed indications:
 

Athlete Information

  
1. First Name        2. Last Name   
3. Date of Birth           4. National Governing Body    
5. Contact Phone No.          6. Email Address

Medical Information

  

1. Diagnosis
 
  2. Generic name of Substance(s) taken         3. Dosage                  4. Units                              5. Date of Administration
             
             
             
             
             

Physician Information

  

1. Name
2. Physician Address                         3. Town
4. Post Code    5. Physician Phone No.

 
  

Declaration Form

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