Health Forms

The Pine School Medical Forms

Click on the appropriate links below to download printable copies of TPS required forms.

  • Please refer to W31 for medical information needed for school enrollment. The FL Certificate of Immunization (DH680) and School Health Entry (DH3040) forms are required to be turned in to the school by July 15th. (Those two forms are provided by your pediatrician).
  • For medication (prescription or over-the-counter) to be given at school, please have a physician or nurse practitioner fill out Physician Authorization for Medication Form (W34)
  • Children who self carry medication need form W35.
  • Children with a history of acute allergic reactions need form W36.
  • Children who have asthma need form W37.
  • Children who have diabetes need form W38.

The Pine School Medical Form Downloads

Parents are required to sign their portion of the forms.  Parents/guardians may FAX forms to physician’s office to obtain signature. The physician may FAX the forms directly to the upper or lower school offices.