School Based Health

 

School-Based Health centers are conveniently located in schools or on school campuses. Our eight school-based health centers see students, parents, teachers and community members for primary care. School-Based Health helps keep kids healthier and in school. Download the enrollment form for your student today:

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HIPAA compliant School Based Health Enrollment Packet

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Counseling Referral Form

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Mental Health Patient History Form

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COVID-19 Testing Consent Form

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COVID-19 Student Vaccine Consent Form

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HPV Vaccine Consent Form

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TDAP Vaccine Consent Form

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Meningococcal Vaccine Consent Form

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Meningococcal B Vaccine Consent Form

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Hepatitis A Vaccine Consent Form

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Hepatitis B Vaccine Consent Form

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Flu Vaccine Consent Form

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MMR Vaccine Consent Form

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Polio Vaccine Consent Form

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Varicella Vaccine Consent Form

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Sports Physical Form (Print Only)

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Health Educator Survey

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Our School-Based Health Sites:

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Coal City Elementary

Fayetteville PK-8

Independence Middle School

Independence High School

New River Elementary

Oak Hill High School

Summersville Wellness Center

Valley Wellness Center

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Or if you prefer the PDF form:  Enrollment Form

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