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Medical Form

Student Details

First Name*

Surname*

Date of Birth*

Class*

Medical Information

Doctor's name*

Tel. No.*

Practice address*

Please provide your child's NHS number*

Does your child have any medical conditions/allergies school should be aware of? If so, please detail here

Is your child currently taking any medication?*

If you answered yes to the previous question, please provide details here

Will it be neccessary to give medicine in school?*

If yes, you need to fill in an 'administration of medicine request form' in the school office.

For certain medical conditions e.g. asthma, epilepsy, it will be neccessary for school to put together a care plan for your child. Please make school aware if you think your child needs a care plan.

Once you press submit, the form will be sent to us and a pop-up box will appear at the top telling you that the form has been submitted (This could take up to a minute to pop up). If this box does not appear, please check that all questions marked with * have been completed. Any questions missed will be highlighted red.

Alternatively print this form, complete it and return it to:

Cookridge Primary School

Tinshill Drive

Cookridge

Leeds

LS16 7DH

Contact Us

Tinshill Drive
Cookridge
Leeds
West Yorkshire
LS16 7DH

0113 386 2500

info@cookridge.leeds.sch.uk