Student Physicals July 11, 2024

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These MSHSAA required physicals are being provided by Dr. Daniel Rudolph and Dr. Joshua Boldt from Kidz Biz Pediatrics. The cost is $25 payable in cash at time of appointment.

Physicals will be performed in the high school health room. Parking will be in the circle drive in front of the high school that can be accessed from Westwind Drive and St. Mary's Lane.

If Dr. Rudolph or Dr. Boldt find any abnormalities during the physical such as a heart murmur or an irregularity in the scoliosis exam, they will not sign the physical form and further follow-up with the primary care physician will be required.

E-mailadres *

Student's Legal Name *

Student's Date of Birth *

JJJJ

Sex assigned at birth *

Male

Female

Grade your student will be entering in the 2024-2025 school year *

Name of Parent/Guardian *

Contact phone number for Parent/Guardian *

Select your appointment time *

Thank you for signing your child up for their physical. If you are able, please print this form and complete the first 2 pages prior to your arrival to this appointment. Reminder that $25 cash is required payment at time of the appointment. If you have questions, please contact Amy Horrell, Coordinator of staff and student wellness via email at horrellamy@festusedu.com

https://www.mshsaa.org/resources/SportsMedicine/MSHSAA-PPE-MH-SSMB.pdf

Printed and will complete prior to appointment

I do not have access to a printer and will arrive 10 minutes before appointment to fill out at that time

Een kopie van je antwoorden wordt gemaild naar het adres dat je hebt opgegeven.

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