Health Office Forms

The Medication Form (see Related Files below for form)is required for a student to receive any medication at school, prescription or any over the counter medication. (Do not use this form for asthma or Epi-Pen). See Asthma or Allergy link.

For Valleyview only:If a student is considering any sport activity at Valleyview (intramural or interscholastic) a state mandated physical package must be completed in order to participate in the sport activity (this includes try-outs). These forms must be complete, and returned to the Valleyview Health Office 2 weeks prior to try-outs to allow for medical clearance by the school physician.

For Lakeview and Riverview Schools only: Physical form

See Related Files below for important health office forms:

Medication Form(PDF 118 KB)

Record of Immunizations Form (PDF 418 KB)
2017 updated

Self medication for Life Threatening Conditions (asthma and Epi-pen only) (PDF 12 KB)

Physician Order Form: Allergy Action Plan (DOCX 44 KB)

Annual Health Update Form (DOC 28 KB)
Parents: please use this form to update us on new information you need us to be aware of regarding your child's health and well-being.

Asthma Action Plan Form (PDF 763 KB)


Physical Exam for Child Health Records

    Click this link to get the physical exam form for your pediatrician to complete during a routine physical check-up or if you are registering your child to enter school. A recent physical exam is required as part of the registration process, and for keeping your child's school health records up-to-date.

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    pdf file: You need Adobe Acrobat Reader (version 7 or higher) to view this file. Download the free Adobe Acrobat Reader for PC or Macintosh.

    doc file: You need the Microsoft Word program, a free Microsoft Word viewer, or a program that can import Word files in order to view this file. To learn more about the free Microsoft Word Viewer, visit the Microsoft Word website.

    docx file: You need the Microsoft Word program, a free Microsoft Word viewer, or a program that can import Word files in order to view this file. To learn more about the free Microsoft Word Viewer, visit the the Microsoft Office Compatibility Pack.


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