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Medical Form

 
Child’s Forename
Child’s Surname
Date of Birth
Name of Family Doctor
Name of Medical Practice
Address
Street
Town
County
Postcode
Medical Practice telephone number
 Date if known
Hib (meningitis)
MMR
Diptheria
Tetanus
BCG
Polio
Pertussis (whooping cough)
 YesNo
Allergies
Asthma
Epilepsy
Diabetes
Bowel or bladder problems
Eczema
Other long-term condition
 YesNo
Has your child ever had a medical examination at a previous school?
Has your child had a hearing test?
 YesNo
Has your child had a sight test?
 YesNo
Does your child have a current health problem?
 YesNo
Has your child had any operations or hospital investigations?
 YesNo
Is your child having special dental treatment?
 YesNo
Has your child lived overseas or had any tropical illnesses?
Does your child wear spectacles?
Do you consider him/her fit to take part in normal games & activities?
Has he/she full bladder control by day and night?
Do you give consent to the school to review your child’s health development (e.g. via a school nurse)?
 
Artificial colour allergy
No dairy produce
No nuts of any type
Gluten Free
Vegan

We have a dedicated School Nurse who in partnership with the School provides care and support to all children. For those children who may have a specific health need such as asthma, a care plan will be created. The School Office will be in contact with you to arrange support for more serious health conditions, please feel free to contact us prior to your child starting school.