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To evaluate current preparticipation physical evaluation (PPE) clinical practice behaviors.Telephone and Web-based survey study with attention to utilization of the Fourth Edition PPE Monograph.We contacted the Washington State American Academy of Pediatrics (AAP) and American Academy of Family Physicians (AAFP) chapters, all Washington State high school athletic directors (ADs), and every state high school athletic association.Data collection and analysis regarding clinical practice.Awareness and utilization of the Fourth Edition PPE Monograph.The response rate was 72% (559/776) from the AAP, 56% (554/990) from the AAFP, 75% (317/424) from the ADs, and 100% (50/50) from the state athletic associations. Few physicians (37%) and ADs (6%) reported an awareness of the PPE Monograph. Knowledge of the Monograph did not vary by physician type, practice/school location, or experience (P > 0.05). Reported obstacles to the delivery of the PPE included time with patient (56%) and the lack of a standard form (52%). Physician awareness of the Monograph reduced the perception of obstacles (P < 0.01). Athletic directors reported financial limitations of the family as the primary obstacle (62%). Adoption of a single statewide PPE form was well supported (96% of physicians and 67% of ADs). Nationally, only 46% of state athletic associations mandate a single form, and only 16% use a form consistent with the Fourth Edition PPE Monograph.The medical community is largely unaware of national screening guidelines. New directions for education and policy are necessary to improve this implementation gap.