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Medication, Physical Exam, and Dental Forms
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NYS School Health Exam Form (Updated 2021)
Please submit a physical exam each year for new enrollment and for grades PK, K, 1, 3, 5, 7, 9, and 11.
A doctor's office form with the same elements and format (Physical Exam, Height/ Weight/ BMI, Allergies and Chronic Conditions, Problem List, Screenings, and Recommendation for Participation) that is signed or electronically signed by the healthcare provider (MD, DO, NP or PA) is also accepted.
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Dental Health Certification (Optional)
Please submit each year for new enrollees and for grades K, 1, 3, 5, 7, 9, and 11.
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Opt-Out for BMI/ WSC Reporting (Optional)
As part of a required school health examination form, a student is weighed and his/her height is measured, which are used to calculate the student's body mass index (BMI) and weight status category (WSC). NYS Education Law requires that BMI and WSC be included as part of the student's school health exam and a sample of school districts will be selected to take part in a survey by the Department of Health each year. If our school is selected, only summary information is sent (no names and no information about individuals). However, you may choose to have your child's information excluded from this survey by returning this form to the School Nurse's Office.
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Updated Sports Health History Form (2021)
Please complete an updated Health History within 30 days of the start of each athletic season for any grades 9 thru 12 student participating in interscholastic sports for the 2021 adjusted sports seasons. Return to the school nurse.