Clinic Forms

The following forms are available for download. Please work with your child's health care provider to complete this plan and return to the school nurse. The forms need to be renewed every year unless there is a specific expiration date.

If your child has emergency medications prescribed such as inhalers/EpiPens/diabetic supplies, please make sure that you provide these to the nurse the first day of school or prior. All medications must be in the original unexpired container or appropriately labeled pharmacy containers.

If your child's medical care provider allows them to carry their emergency medication with them, please make sure they have it with them on a daily basis.

Over the Counter Form

Virginia School Health Entrance Form

VISAA Form

Prescription Authorization Form

Asthma Action Plan

Diabetes Management Plan

Migraine Action Plan

Seizure Action Plan