Anxiety Update Form

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Anxiety Update Form

Please take a few moments to answer the following questions.
Your answers will be used to create an individualized school healthcare plan for your child.
Also, information will be shared on a need to know basis with school personnel for health, safety and educational purposes.

Email *

Student's Legal Name (last, first) *

Student Graduation year *

Student Date of Birth *

YYYY

Current Medical Diagnosis *

List current medications- note whether any are taken during school time... Medication Form *

List any special accommodations your child might need in order to be successful during the school day... *

Doctor Name and Number... *

Person/Parent name completing this form... *

Submit

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This form was created inside of East Peoria High School Dist 309.

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