Health Services Forms
Health Services Forms
In compliance with Senate Bill 12, all Texas school districts must receive parent or guardian permission for nurses, athletic trainers and school counselors to attend to students in certain situations. These can include routine counseling and health-related services.
If you want your child to continue receiving all services that require written parental consent, please fill out the form below. Forms must be filled out for each student. Please be aware that a delay in submission will prevent the prompt implementation of these services for your child.
Fairfield ISD Health Care and Health Services Form for Parents
Will your child need medication at school?
You will need to complete the Medication Administration Permission Form.
Medication Administration Permission Form – Spanish
Does your child need to carry an inhaler?
The following form needs to be completed by you and your healthcare provider:
Asthma Respiratory Distress Action Plan
Does your child have a severe allergy requiring a physician prescribed epinephrine auto-injector?
The following form needs to be completed by you and your healthcare provider:
Does your child have diabetes?
Please contact your campus nurse to set up a meeting via phone or Zoom to discuss your student's needs for the coming school year.
Does your child have seizures?
The following form needs to be completed by you and your healthcare provider:
Seizure Management and Treatment Plan Form
Seizure Management and Treatment Plan Form – Spanish
Does your child have special dietary needs?
The following forms needs to be completed.
Does you child require feeding assistance?
The following form needs to be completed by you and your healthcare provider:
Is there any other health information you would like to share with the school nurse?
Please contact the nurse on your campus.
If you have any questions about the forms above or if your child has a health condition that will require special consideration at school, please contact the campus nurse at your child's school.
Other Forms:
Affidavit Request for Exemption from Immunization for Reasons of Conscience