Health Office Forms


To download any of the forms below, please click on the bold and underlined type.

CLICK HERE TO RETURN TO THE HEALTH OFFICE INFORMATION PAGE


Medication Permission Form

To be completed for any prescription/over the counter medications that are to be administered at school or on field trips/school sponsored events

Permission Form For Independent Medication Carry And Use
To be completed for medications that require rapid administration to prevent negative health outcomes; i.e. asthma, diabetes, seizures, anaphylactic allergic reactions

Hearing/Vision Screening Form
Complete this form only if you DO NOT want student screened in school

Family Food Allergy Health History Form
To be completed for any student that has allergies that may require medical intervention 

Asthma Action Plan Form
To be completed by student’s physician and returned to health office

Allergy and Anaphylaxis Emergency Plan
To be completed by student’s physician and returned to health office
NYS School Heath Examination Form To be completed by student’s physician and returned to health office
Dental Certificate To be completed by the student’s dentist and returned to the health office
Interval Health History Form To be completed and signed by parent PRIOR to each sports season for review by school nurse
Return To Play Form

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