Health Forms

  • The following health forms are available for download. To request a physical copy or for additional information, contact school nurse Peggy Ziel by phone: 815-220-2738, email:, or confidential fax number: 815-223-3507.

    Certificate of Health Examination Form

    School Medication Authorization Form

    Eye Examination Waiver Form

    Food Allergy Emergency Action Plan
    Religious Exemption to Required Immunizations and/or Examinations Form
    Asthma Action Plan & Medication Request Form
    Proof of Dental Examination Form
    Diabetes Medical Management Plan