Health Forms

• Student Health History [pdf]
  Must be completed by the doctor at the time of your student’s physical exam. This form must be signed and dated by the physician and returned to the STA Health Office. All immunizations must be included.
  
  
• Sports Qualifying Physical Examination [pdf]
  For all athletes participating in a High School League sport grades 7-12. A physical exam is required every three years. Return to Athletic Office.
  
  
• Consent To Share Student Health Data [pdf]
  This form will allow the Health Office staff to share health concerns with appropriate school personnel who have direct contact with your student during the school day.
  
  
• Student Health Form [pdf]
  This form must be completed and returned to the STA health office.
  
  
• Consent For Administration of Medication in School [pdf]
  This form must be signed by both the parent and the physician in order for your child to receive medication in school. Only medications prescribed by a physician, in writing, will be dispensed in the Health Office. This includes all over-the-counter medications.
  
  
• Asthma Questionnaire [pdf]
  Please fill out this questionnaire for your student if they have asthma.
  
  
• Parent/Guardian Asthma Questionnaire [pdf]
  Please fill this questionnaire out if your child has asthma. Return to the STA Health Office.
  
  
• Food Allergy Action Plan [pdf]
  This form is to be completed if your child has any food allergies.
  
  
• Epi-Pen Letter [pdf]
  This form is to be completed and signed by the physician authorizing the Health Office Staff to administer the epi-pen to your child.
  
  
• Blood Glucose Consent Form [pdf]
  This form must be filled out, signed and returned to the STA Health Office.
  

• Diabetes Parent Questionnaire/Daily Routines [pdf]
  This form is to be completed for your child with diabetes along with the Daily Diabetic Routine included in this form.
  
  
• Independent Blood Glucose Monitoring Authorization [pdf]
  This form must be completed by a physician and parent/guardian and returned to the STA Health Office. Orders must be renewed annually.