School medical form

July 1, 2011

School medical form is a very important piece of document for your child’s safety. It has all the important information of your child including his insurance details, vaccinations and medical conditions. This form proves to be very helpful when your child faces any kind of emergency in the school as needed medical steps can be taken with its reference.
Sample school medical form:

Q1) Student’s full name:

Q2) Name of guardian:

Q3) Age:

Q5) Present grade:

Q6) Home address:

Q7) Contact number:

Q8) Name of the student’s primary care physician

Q9) Contact number of the primary care physician

Q10) Is the student covered by any insurance plan? Please specify the plan.

Q11) Who is the primary card holder of the insurance?

Q12) Are the vaccinations up to date?

Q13) is the student suffering from any chronic medical condition?

Q14) is the student allergic to any food product?

Q15) In case of an emergency whom should we contact? Give the full name and contact number.

Please notify the school if there are any changes in the above information

 

Download School medical form in Word Format

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