Forms
Health Forms
Date Range
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This is a required form to document state-required immunizations. Learn more about NYS immunization requirements here.
This is the NYS required health examination form.
Note: NYSED requires a physical exam for new entrants and students in Grades Pre-K or K, 1, 3, 5, 7, 9 & 11; annually for interscholastic sports; and working papers as needed; or as required by the Committee on Special Education (CSE) or Committee on Pre-School Special education (CPSE).
This action plan is only for students with a diagnosis of asthma.
New York State law (Chapter 281) permits schools to request an oral health assessment at the same time a health examination is required. This form is not required.
This form is only for students who are prescribed epinephrine and may need an Epi-pen/Epi Jr/Auvi-Q in school.
This form is required for Westorchard families only.
This form is required for any long-term medication needs in school.
This form is only for students with a peanut/nut allergy.
This form contains suggestions for adjustments requested to support a student’s recovery after a concussion diagnosis.
This form is required for any short-term medication needs in school.
This form is used to share or report results of vision screenings.