Health History Questionnaires

Health History Questionnaires

For students who have medical conditions, information is extremely helpful when treating your child. Our district has health questionnaires for conditions listed below, please click on the link to access the history. You can print and return it, or save and email it to your school’s Health Clerk Technician. Please also provide any pertinent doctor documentation. If you have information regarding a student’s medical condition that is not listed, please also provide that to your school’s Health Office.

All Forms are in English and Spanish

• Allergies – General Allergy History

• Allergies – Bee Sting & Insect Bee Sting Insect History Cancer Cancer Health History

• Diary Egg/ Egg Allergy Health History

• Diabetes Diabetes Health History Ear Health Ear Health History

• Feeding (for GI medical conditions) Feeding Health History General History General Health History

• Heart Health Heart History Hemophilia Hemophilia Health History Migraine Headaches Migraine History

• Seizure Disorders Seizure Health History Sickle Cell Anemia Sickle Cell Anemia History

• Tourette’s Syndrome History Tourette's Syndrome History