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  • Brookhaven Student Health Form

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  • Provider Information

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  • Insurance Information

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  • Counseling

  • Medications

    Provide all daily medications, reason, dosage, and time given to child.
  • Emergency Medications

    Does your child take any emergency medications?

  • Any prescription medication to be administered by Brookhaven staff must be sent in with the original prescription labeled container, and the Authorization to Dispense Prescription Medication form must be completed by the prescribing physician.

  • Medical History

  • Permission to Administer Over the Counter Medications

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  • Occasionally the school needs to contact your child’s physician regarding immunizations, medication or other significant health or pertinent medical information. By signing below I consent to the release of medical records of my student for this educational purpose. I understand this authorization will expire at the end of the school year unless I specify otherwise.
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