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Health Services Forms

The following forms are provided - Acrobat Reader required to view/print. 
Please select the section for your school:

Brentwood / Swasey Central Elementary School

• Medication Permission Forms
  • Physician's Request for Medication Administration Form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  • Physician's Report of School Health Examination Form (.pdf)

Cooperative Middle School

• Medication Permission Form
  • Physician's Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  • Physician's Report of School Health Examination Form (.pdf)

East Kingston Elementary School

• Medication Permission Form
  • Physician's Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  • Physician's Report of School Health Examination Form (.pdf)

Exeter Elementary - Lincoln Street School

• Medication Permission Form
  • Physician's Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  • Physician's Report of School Health Examination Form (.pdf)

Exeter Elementary - Main Street School

• Medication Permission Form
  • Physician's Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  • Physician's Report of School Health Examination Form (.pdf)

Exeter High School

• Medication Permission Form
  • Physician's Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  All students who plan on taking part in interscholastic athletics MUST have a current Athletic Physical Examination Form on file at their school prior to participation. In the event of a student suffering a prolonged illness or injury under the care of a physician, a physician must provide written permission before the student may return to athletic participation. In the event of an injury, when a physician is not responsible for the care of a student, the athletic trainer will determine whether or not that student may participate in athletics.
  • Physician's Report of School Health Examination Form (.pdf)

Kensington Elementary School

• Medication Permission Form
  • Physician's Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form  
  • Physician's Report of School Health Examination Form (.pdf)

Newfields Elementary School

• Medication Permission Form
  • Physician's Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  • Physician's Report of School Health Examination Form (.pdf)

Stratham Memorial School

• Medication Permission Form
  • Physician's Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  • Physician's Report of School Health Examination Form (.pdf)

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NH Dept. of Education Administrative Rules

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