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Health Forms

In order to continue to provide the best possible health care for students, we need your help. To keep the school updated with the latest emergency and health information for your child, there are important forms and information that we need you to provide. These forms may not apply to every child. Please carefully read the below options to identify which forms you will need to complete and return to school for your child and his/her health needs.

Annual Health Form - Must be completed for all students

This form is for all students in all grades and is completed by the parent(s). If you are a current family, please complete this form through the SchoolForms Online portion of the Parent Portal.  New families should fill out the form, save it and submit it by email or print it and return it to the school nurse as a hard paper copy. Select this link to view the Annual Health Form.

Physical Exam Report - Must be completed for all new students, students entering grade 6 and sports participants

This form is for students new to Falk School, as well as, students entering grade 6 and students who plan to participate in extra curricular sports.  This form is completed by your health care provider. Select this link to view the Physical Exam Report.

Blood Lead Level Testing Form – Must be completed for all students entering Kindergarten

New Allegheny County regulations require lead testing for all children in the county. Students entering Kindergarten will need to show that they have received blood lead level testing. This form can be completed by your health care provider, or your health care provider can make available any form of documentation that shows the child has received this blood lead level testing. Select the link to view the Allegheny County Lead Testing Form. If you choose to be exempt from testing, please select the link to view the Allegheny County Statement of Exemption to Lead Testing.

Please have the form completed and returned to the School Nurse with the child’s Physical Exam Report.

Dental Exam Report - Must be completed for all new students and students entering grades 3 & 7

This form is for students new to Falk School and all students entering 3rd and 7th grades.  This form is completed by your dentist. Select this link to view the Dental Exam Report.

Medication Administration Form

This form is to accompany every medication, both over-the-counter and prescription, brought to school and is completed by the parent and health care provider.  See our Medication Policy for more information. Select this link to view the Medication Administration Form.

Sports Forms

If your middle school child is interested in participating in a sport - Cross Country and Soccer in the Fall, Basketball in the winter, or Tennis and Baseball in the Spring - please read carefully and follow the specific instructions on the attached forms.

Please know all middle school student athletes MUST have the following three forms completed and returned to the school nurse prior to participating in any practice, scrimmages, or regularly scheduled sporting events.

Allergy Action Plans

These plans should be completed by both the parent and health care provider for students with severe allergies. The forms are designed so that some of the information can be typed in and printed at home.  Please take them to the student’s physician / healthcare provider to complete.

School Children Immunization Requirements

The Pennsylvania Department of Health states that "Students at any grade, Kindergarten through 12th, including all public, private, parochial or nonpublic school in this Commonwealth must show proof of immunization before they can attend school. This pertains to vocational schools, alternative education programs, intermediate units, special education, home education programs, charter and cyber charter schools."  School Children Immunization Requirements