Forms

Physical Form:

• Child Health Exam
• Child Health Exam With Parent Section
• Form Child Health Exam Spanish
• SPORTS PHYSICAL FORM  (This can’t be used for the school physical)

Dental Forms:

• Dental Exam Form 2022
• Dental Exam Form 2021 Spanish Final
• Dental Exam Waiver 2021 Spanish Final
• Dental Exam Waiver 2021

Meningococcal Form:

• ACHD Consent Meningococcal

Wellness Express Forms:

• ACHD School Consent 7.12.18
• SIU Consent Required For All Physicals

Allergy Policy and Forms:

• Guideline For Management Of Children With Life Threatening Allergies Revised 2019
• Allergy Medical Management Plan (Action plan plus orders)
• Physician Statement For Food Substitution

Asthma Forms:

• Asthma Medical Management Plan (Action plan and orders)
• Asthma Questionnaire
• Parental Authorization Request For Self Administration Of Asthma Inhaler
• Parental Authorization Request For Self Administration Of Asthma Inhaler ESP

Seizure Forms:

• Seizure Medical Management Plan (Action plan and orders.)
• Seizure Questionnaire

Diabetes:

• DIABETES MEDICAL MANAGEMENT PLAN 

Medication Forms:

• AUTHORIZATION AND PERMISSION FOR ADMINISTRATION OF MEDICATION 
• AUTHORIZATION AND PERMISSION FOR SPECIALIZED MEDICAL TREATMENT 

(For Seizure, asthma, diabetes, and allergy orders, please refer to those sections located above.)

Eye Exam Forms:

• 2022 Eye Examination Report
• 2022 Eye Examination Waiver

LEAD QUESTIONNAIRE

Other Forms:

• Facts about Meningococcal Disease
• Meningococcal Vaccine Form
• Flu Guide For Parents Brochure
• Religious Exempt Form