Ehrhardt Clinic
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Parents, please complete this page if you would like to notify the Nurse of any health issues or concerns regarding your student. If you have multiple students at Ehrhardt, Please sumbit one online form per child.
Parent first and last name
Student first and last name
Student date of birth
Health Alert
What health. medical condition would you like to notify the Nurse of?
If "Other" was selected please explain.
Is the student under a doctor's care for this condition?
Yes
No
Other pertinent info about this condition Nurse should know to keep your child safe at school.
Medications your child is taking for this condition
What is the best way for nurse to contact you, phone or email.
Please list contact phone numbers or email address.