Managing Your Student's Health Forms
We want our children to have access to healthcare providers who specialize in preventative care and can address chronic conditions and health issues that are unique to children. It is imperative for parents and caregivers to submit health forms for students as soon as possible so they receive much needed health services.
All fillable forms must have an original parent or guardian signature; an electronic signature is not acceptable. By signing these documents, you certify that you are authorized to complete the documents, and the information provided is true and accurate.
Please visit the Office for Students with Disabilities website to learn about 504 and IEP related supports.
Student Health & School Forms Booklet
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Full Booklet
The Student Health & School Forms Booklet contains back-to-school information and CPS health requirements and services. View the full booklet or the individual forms below.
Individual Forms
- Student Medical Information Form [ English | Spanish ]
- Illinois Certificate of Child Health Examination [ English ]
- State of Illinois Proof of Dental Examination Form [ English | Spanish ]
- Dental Examination Consent Form [ English | Spanish ]
- Vision Exam Consent Form [ English | Spanish ]
- State of Illinois Eye Examination Report Form [ English | Spanish ]
- Healthcare Provider Statement for Food Substitution [ English | Spanish ]
- Minimum Health Requirements [ English | Spanish ]
- School-Based Health Centers Directory (SBHCs) [ English | Spanish ]
- Vision Program: Schedule an Eye Exam [ English | Spanish ]
- Asthma Information and Most Frequently Asked Questions [ English | Spanish ]
Medical Forms
Download the forms that are required based on your health condition, medications, or the health requirements for enrolling at your school. Bring these forms to your health care provider and return them to your school. CPS staff will review the forms and may contact the medical provider to clarify services required during school hours.
While these forms often say “physician,” they may also be completed by other medical providers (MD, DO, APRN or PA).
More Resources for Student Health and Wellness
Get Help With Benefits
CPS' Children and Family Benefits Unit (CFBU) connects families to free or low-cost health insurance (Medicaid) and to food through the Supplemental Nutrition Assistance Program (SNAP).
Find a Health Center
Located in or near schools, school-based health centers provide primary care to students at no out-of-pocket cost. Most services require parent or caregiver consent. Call ahead to make an appointment.
Schedule a Health Exam
CPS partners with health care providers to bring essential health services to schools. Schedule vision, hearing, or dental exams for your student.
Need Support with Public Benefits?
The CPS Children and Family Benefits Unit (CFBU) connects CPS families to free or low-cost health insurance (Medicaid) and to food through the Supplemental Nutrition Assistance Program (SNAP). In addition to providing application and redetermination assistance, CFBU also provides parent-focused education to help families maintain and understand how to use their public benefits.
For more information, contact your Network's Children and Family Benefits Coordinator or call the Healthy CPS Hotline at 773-553-KIDS (5437).
Need to Find a Health Center?
Use the Find a Health Center map to find a Federally Qualified Health Center near you. Health Centers can provide you and your family with comprehensive, culturally competent, high-quality primary health care services as well as supportive services such as health education, translation, and transportation that promote access to health care. Federally Qualified Health Centers provide services regardless of a patient’s ability to pay and charge for services on a sliding fee scale.