In order for me to help your child with their individual medical needs, please take a moment to review and fill out the appropriate forms so that I may address their health concerns. These forms, called Action Plans, will need to be filled out if your child has been diagnosed by a physician with any one of the following medical issues. The most commonly used forms can be accessed on this page. Please contact me if you have any additional need for forms.
- Allergies (food, seasonal, chemical, etc.)
- Bleeding Disorder
- Cardiovascular Issues
- Cystic Fibrosis
- Inflammatory Bowel Disease
- Sickle Cell
- Vagal Nerve Stimulator
- V-P Shunt
You may fill out the action plan and email it to me or you may print it out and send it with your child. If your child needs medication to be kept at school, please fill out the Administration of Medication Request form in addition to the action plan. Please bring in any necessary medication directly to the clinic as students may not bring in their own medications. Please refer to the Clinic section in your child's agenda for important information about medication.
If you have any questions, you may email me at firstname.lastname@example.org or call me in the clinic at 770-271-4890 starting the first day of school.
Thank you for your time and cooperation in returning these forms to me as quickly as possible.