The preparticipation physical evaluation (PPE) provides an opportunity to screen for underlying health conditions and promote safe participation in sports. For patients without a primary care physician, the PPE also serves as an entry point into the healthcare system. No high-quality evidence supporting the overall effectiveness of the PPE exists. PPE screening practices vary across states and levels of competition, reflecting a lack of standardization. In the context of cardiovascular screening, a focused history and physical examination can detect certain conditions at minimal cost. In resource-rich settings, the addition of an electrocardiogram (EKG) to the standard PPE may improve sensitivity for identifying cardiovascular disorders associated with sudden cardiac death (SCD).