Templates Education Evaluation Student Health Information Form Template

Student Health Information Form Template

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Student Information

Medical History

Developmental History

Overall Health

The Student Health Information Form Template by WPForms is designed for educational institutes looking for a solution to gather crucial student health data.

How Does the Student Health Information Form Template Work?

The Student Health Information Form Template requires the WPForms Pro License and the Signature Addon to ensure a secure collection of health-related info. Fields include:

  • Student Information:
    • Full Name: Captures the student’s name for personal identification.
    • Date of Birth: Essential for age verification and health service appropriateness.
    • Grade: Helps to record the student’s current educational level.
    • Parent’s Name: Important for emergency contact and parental consent.
    • Phone: A direct line to the parent or guardian for urgent communication.
    • Email: For sending health updates or information directly to the parent.
  • Medical History:
    • Immunization Record: For school health compliance and outbreak prevention.
    • Known Allergies: Alerts staff to potential health risks and necessary precautions.
    • Chronic Illnesses/Conditions: Ensures ongoing conditions are managed.
    • Medications Currently Taken: Vital for understanding daily health needs.
  • Developmental History:
    • Milestones Achieved: Offers insight into developmental history.
    • Frequency of Physical Activity: Gauges lifestyle and physical well-being.
    • Performance in School: May indicate health-related learning barriers.
    • Behavioral Issues: For identifying potential health-related behavior concerns.
  • Overall Health:
    • Typical Daily Diet: Informs nutritional health and possible adjustments.
    • Special Dietary Restrictions: Essential for meal planning and safety.
    • Hours of Sleep per Night: A critical component of student health and performance.
    • Observations/Concerns: Space for additional notes that might impact student health.
    • Signature and Date: Secures formal acknowledgment from the parent or guardian.

Sign up with WPForms today and access the Student Health Information Form Template to ensure each student receives the care they need.