Healthcare Plan for a Student with Medical Needs (2025-26)
This plan should be completed for any student with a medical need at the beginning of each school year. You must contact school if there are any changes to this information during the year.

The form allows you to record up to three medical conditions. If you need to inform us of any additional conditions please include a note in the ‘Additional Information’ section and we will get in touch with you if we require further information.
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Email address
 *
Student Surname
 *
Student Forename
 *
Date of Birth
 *
MM
/
DD
/
YYYY
Year Group 
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Contact 1 Name
 *
Contact 1 Telephone (Mobile)
 *
Contact 1 Telephone (Home)
Contact 1 Telephone (Work)
Contact 1 Relationship to Student
 *
Contact 2 Name
 *
Contact 2 Telephone (Mobile)
 *
Contact 2 Telephone (Home)
Contact 2 Telephone (Work)
Contact 2 Relationship to Student
 *
Medical Practice
 *
GP Name
 *
GP Telephone Number
 *
Clinic or Hospital
Doctor/Specialist Name
Clinic/Hospital Telephone Number
Next
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