Pine Grove Area School District • 103 School Street • Pine Grove, Pennsylvania 17963 • 570.345.2731

School Health Forms

Private Physical form

  • use this if you are going to your own doctor for the school physical, which is required for grades K, 6, and 11.

    • Private Dental form

  • use this if you are going to your own dentist for the school dental exam, which is required for grades K, 3, and 7.

    • Eye Specialist report

  • needed for every student who received a referral form from the school nurse, indicating that the student failed the school vision screen.

    • Medication Order form

  • use these if your child needs to take medication during school hours

    • Asthma forms

  • use these if your child uses asthma medication

    • Over the Counter Medication permission form

  • use this if you wish to allow your child to receive Actaminophen, Ibuprofen, Tums, or Mylanta during school hours.

    • Medical Plan of Care for School Food Service

    • use this if your child has a food allergy or special dietary need.