Wakefield Public Schools Health Form

In an effort to have our health records complete, we request that this form be completed for the upcoming school year. If there are issues you wish to discuss, please contact the health office anytime through a note or phone call.
Thank you for your cooperation.

Wakefield School Nurses

School: *

Student ID #: 🛈

Student's First Name *

Student's Last Name *

Grade Level *

Does your child have any allergies (food, insect bites, medications, etc.)? *

Yes

No

Please specify your directions for care for allergies *

Does your child have any medical conditions (asthma, seizures, diabetes, etc.)? *

Yes

No

Please specify your child's medical conditions *

Asthma

Seizures

Diabetes

Other Other