School Based Health Center

Student Enrollment/Health Form

 

 

Registration Form – all students

      English:   https://www.childandfamilyagency.org/forms/forms-school-based/forms-sbhc-registration/

      Spanish:  https://www.childandfamilyagency.org/forms/forms-school-based/forms-sbhc-registration-spanish/

Health Assessment Record (first page of blue form) – all PEs

      English:   https://www.childandfamilyagency.org/forms/forms-school-based/school-based-health-assessment-record/

      Spanish:  https://www.childandfamilyagency.org/forms/forms-school-based-spanish/registro-de-evaluacion-de-salud/

Pre-participation History Form (just for student athletes)

      English:  https://www.childandfamilyagency.org/forms/forms-school-based/forms-sports-physical/

      Spanish: https://www.childandfamilyagency.org/forms/forms-school-based/forms-sports-physical-spanish/

Vaccine Consent Form (general)

       English:  https://www.childandfamilyagency.org/forms/forms-school-based/forms-vaccine-consent/

      Spanish:  https://www.childandfamilyagency.org/forms/forms-school-based/forms-vaccine-consent-spanish/

Flu Vaccine Consent Form

       English:  https://www.childandfamilyagency.org/forms/forms-school-based/forms-flu-vaccine/

       Spanish: https://www.childandfamilyagency.org/forms/forms-school-based/forms-flu-vaccine-spanish/

COVID Vaccine Consent Form

       English:    https://www.childandfamilyagency.org/forms/forms-school-based/forms-sbhc-covid-19-vaccine-consent-form/

       Spanish:   https://www.childandfamilyagency.org/forms/forms-school-based-spanish/forms-sbhc-covid-19-vaccine-consent-form-spanish/

Asthma Control Test (students referred for albuterol/inhaler med authorizations- ages 4-11)

        English:   https://www.childandfamilyagency.org/forms/forms-school-based/forms-asthma-control-test-ages-4-11/

        Spanish:  https://www.childandfamilyagency.org/forms/forms-school-based/forms-asthma-control-test-ages-4-11-spanish/