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3V Medical Forms

Three Village CSD

Medical Forms

Required Medical Forms

  • Immunization Certificate (Grades Pre-K-12)  - Immunization documentation required for registration

  • Health History (Grades Pre-K-12)  NEW ENTRANTS ONLY

  • Required NYS Health Examination Form  (Grades Pre-K, K, 1, 3, 5, 7, 9, 11 only)

      • FAQs - NYS Required Health Examination

  • Dental Health Certificate (Grades Pre-K, K, 1, 3, 5, 7, 9, 11 only)

Additional Medical Forms (As Applicable)

Students are not permitted to take medication while at school unless such medication is administered by the authorized school personnel acting under specific written request of the parent or guardian and under the written directive of the student’s personal physician. This policy covers all prescriptions, as well as over-the-counter medication e.g., Tylenol, Ibuprofen. Please refer to the Board of Education Policy for more detailed information. 

BOE Policy on the Administration of Medicine in School

Guide to Determining Assistance in Medication Delivery

  • Authorization of the Administration of Medication Form


If you do not wish to have your child's weight status group information included as part of the NYS Health Department's survey please complete the BMI Opt-Out Letter

BMI Opt-Out Letter


Emergency Care Plans for Allergy/Anaphylaxis, Asthma, and Seizure Disorders must be completed in their entirety by an authorized Health Care Provider.  

  • Allergy Medication Authorization and Emergency Care Plan

  • Asthma Medication Order Emergency Care Plan

  • Seizure Medication Authorization and Emergency Care Plan


Requests for Exemption from wearing a face mask or from NYS DOH Immunization requirements must be completed by an authorized Health Care Provider.

Exemption Form:

  • Medical Exemption Form for Immunizations

Contact Information:Erin ConnollyAsssitant to the Superintendent for Pupil Personnel Services631-730-4574
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