Skip To Main Content
Close Menu
Search
Clear
Search
Home
District
Resources
Calendar
Departments
News
Contact Us
Canvas
ClassLink
PowerSchool
Email
(opens in new window/tab)
District
Schools
Cantiague Elementary School
George A. Jackson Elementary School
Jeffrey Ratner Robert Seaman Elementary School
Jericho High School
Jericho Middle School
District
Schools
Cantiague Elementary School
George A. Jackson Elementary School
Jeffrey Ratner Robert Seaman Elementary School
Jericho High School
Jericho Middle School
Jericho Union Free School District
Canvas
ClassLink
PowerSchool
Email
(opens in new window/tab)
Open Search
Search
Clear
Search
Open Menu
Home
District
Resources
Calendar
Departments
News
Contact Us
In This Section
Home
>
Departments
>
Health Office Forms
NYS Physical Examination
Mandated NYS Physical Examination Form
This form MUST BE COMPLETED IN FULL by a NYS licensed Medical Doctor, Physicians Assistant or Nurse Practitioner.
The completed form must be signed and stamped by the Health Care Provider.
Please return or
E-mail
completed form to the school nurse immediately after your child receives his/her physical exam .
Form Instructions for Printing
