Health Services Forms

• 

We accept physical and immunization records that are printed out from the physician’s office. Please make sure there is a statement of health and any physical limitations. If your child’s physician does not provide a printout, feel free to use the appropriate form below.

The following forms are provided in .pdf format. The free, Adobe® Reader® software is required to view and 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)
• Physician's Request for Medication Administration form (.pdf)
  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)

---

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)

---

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)

---

Main Street School

• Medication Permission Form
  • Physicians Request for Medication Administration form (.pdf)
  • Parental Form for dispensing of medications in school (.pdf)
• Physical Form
  • Physicians 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)