Commonly Used Health Forms
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Health/Physical Exams:
- Preschool - 5th Grade (completed by health care provider)
- 6th - 12th Grade (also used for sports physical; completed by health care provider)
Immunizations:
- Pre-Kindergarten - 12th Grade Immunization Record (includes child care & conscientious objection to immunizations)
Authorizations/Releases/Consent forms:
- Authorization for the Administration of Medication/Treatment
- Release of Information (ROI) Authorization
- Self-Administration of Medication Authorization (completed by health care provider)
- Overnight Field Trip Authorization
Specifically for students with anaphylaxis, asthma, diabetes, and/or seizures:
- Authorization for the Administration of Medication/Treatment
- Self-Carry, Self-Administer Medication Agreement
- Allergic Reaction Questionnaire
- Asthma/Breathing Questionnaire
- Diabetes Questionnaire
- Seizure Questionnaire
Contact your health care provider to obtain a copy of your child's anaphylaxis, asthma, diabetes, and/or seizure action plan. Provide a copy to the health office at your child's school.
Completed forms can be emailed to: student.wellness@spps.org