Health Forms

School, Camp, Daycare Health Forms

child nutritionYour child’s school, camp or daycare may require a form to make sure their physical exams and immunizations meet specific criteria before they will be allowed to attend. 

The State of Illinois requires a DCFS health form to be completed by a physician for all students entering preschool and kindergarten, students entering any State of Illinois school for the first time at any grade level, students entering 6th and 9th grade and for college freshman.

Forms for you to mail or turn in to Town & Country can be accessed on this page. Town & Country will mail, email or fax your forms, per your request, or you may pick them up at your office. Your child must have had a check-up at Town & Country Pediatrics in the last twelve months for us to complete these forms.

So Town & Country can process your forms in a timely manner, it is very important that you fill out all demographic fields, and answer all of the HEALTH HISTORY questions on the DCFS school form, and that you complete the Town & Country form included. Your Town & Country Pediatrics office will complete your child’s health form within seven to ten business days.

AN IMPORTANT REMINDER: Please remember to make a copy of your child’s form before you forward it. There is a $15 administrative charge for additional copies made within a twelve month period.

 

Forms

  • School Form - State of Illinois Certificate of Health Examination - This is the form commonly used by many schools, camps or day-care providers to document your child's health history. We provide an annual update of your child's health history as a courtesy to all families. Please remember to photocopy the completed form before turning it in to your school, camp or day-care provider. There is a nominal charge for the completion of more than one form per year. Please remember to give us at least ten business days notice if you need one of these forms for the school, camp or daycare center you are planning on attending. Thank you.
  • Athletics - State of Illinois Pre-participation Examination Form - Check with your child's program to make sure that this is the preferred health form for participation in their athletic program. There is a nominal charge for the completion of more than one form per year. Please remember to give us at least seven days notice if you need one of these forms before they are allowed to participate in an athletic activity.

Questions about forms for your child?

contact your Town & Country office
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