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Health Forms for Parents and Caregivers

The health and safety of your children is always our top priority, especially during a public health emergency. Every child has a fundamental right to high-quality healthcare.

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 of Diverse Learner Supports and Services website to learn about 504 and IEP related supports.

Student Health Forms Booklet

The Student Health Forms Booklet includes all the forms that parents and caregivers must complete for their students at the beginning of the school year. Among the forms that the booklet includes are the Student Medical Information Form, Vision and Dental Consent Forms, Emergency Contact Form, Media Release Form and School Messaging Form. 

View the Student Health Forms Booklet as a single document  [ ENGLISH | SPANISH or view the individual forms included in the booklet below.

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).

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.

Student Health and Wellness

773-553-KIDS (5437)

42 W. Madison St.
Chicago, IL 60602