Health Services Forms

Health History/Emergency Form

Please complete this form upon enrollment or if there are changes to medical information or emergency contacts.

Medication Authorization Form

Your student's clinic will need a Medication Authorization Form for each medication kept in the clinic. If the medication is a prescription a physician's signature will be required.  Please make sure all medications are in their original containers and are not expired.  We are unable to administer expired medications.

Food and Environmental Allergy Form

If your child is allergic to any foods or environmental allergens please complete the following form. 

Anaphylaxis/Allergy Action Plan

If your student has a history of severe allergic reactions and may need Benadryl or an EpiPen while at school please complete the Anaphylaxis Action Plan. 

Seizure Action Plan

If your student has a history of Epilepsy please complete the Seizure Action Plan. 

Asthma Action Plan

If your student has been diagnosed with Asthma we would like to have an Asthma Action Plan form on file and an inhaler or nebulizer treatments in the clinic. 

Generic Action Plan

If your child has any health condition not already listed above, please have his/her physician complete this form and return it to the school nurse.