Health Forms Upload

This form may be used to securely send a picture or scanned PDF copy of completed health documents to your student's health office.
Documents such as:

  • Student Physical Forms (mandatory for incoming Kindergarten, 6th grade, and new D34 students)
    Due by: First day of school (if not submitted, student will be excluded)
  • Dental Exam Forms (mandatory for incoming Kindergarten, 2nd and 6th graders)
    Due by: May 15 (may be submitted earlier)
  • Vision Exam Form (mandatory for incoming Kindergarten or anyone new to an Illinois school)
    Due by: October 15 (may be submitted earlier)

For more information on school health requirements and to download the needed forms for your doctor/dentist to fill out visit:

PLEASE NOTE: This form is for a single student. If you have multiple students in the district you must fill out the form once for each student.
Used by health staff to communicate about the uploaded documents.
Upload a PDF version or picture you have taken of the documents
Required Health Exam Parent Questions
(Food, drug, insect, animals, environmental, other)
(Prescribed or taken on a regular basis.)
Diagnosis of asthma?
Child wakes during night coughing?
Birth defects?
Developmental delay?
Blood disorders?
(Hemophilia, Sickle Cell, Other)
(What are they like?)
Head injury/Concussion/Passed out?
Heart problem/Shortness of breath?
Heart murmur/High blood pressure?
Dizziness or chest pain with exercise?
Eye/Vision problems?
(crossed eye, drooping lids, squinting, difficulty reading)
Ear/Hearing problems?
Bone/Joint problem/injury/scoliosis?
Loss of function of one of paired organs?
When? What for?
When? What for?
Serious injury or illness?
TB skin test positive (past/present)?
*If yes, refer to local health department.
TB disease (past or present)?
*If yes, refer to local health department.
Tobacco use?
(type, frequency)
Alcohol/Drug use?
Family history of sudden death before age 50?
Other dental
By checking the following box,
I, provide my electronic signature and verify that all information contained above is accurate and correct.