School Medication Request Form

Please correct the errors described below.

Please review the following:

Electronic School Forms through the Portal:

  • All school forms processed through the patient portal (My Chart Plus) will continue to be free of charge.
  • Please expect no more than 14 days turnaround from the time of the request for electronic forms processed through the portal.
  • You MUST have portal access activated to receive forms.
  • If you need an activation code, please note this request and look for the activation code in your email.
  • All patients 13 - 17.99 years of age must activate their own account as proxy accounts for this age cannot receive school forms.

Electronic School Forms Printed:

  • Any electronic school forms that are printed for mailing to the home are subject to a $5 per form fee.
  • Please expect up to 7 additional days (21 days total) to receive mailed school forms.

Specialty School Forms:

  • Any special forms that are school or daycare specific to be completed by hand may take up to 4 weeks to process.
  • Please include a self-addressed stamped envelope.
  • These will be mailed home and are subject to a $15 per form fee

Forms will not be faxed or emailed

While every effort is made to complete the forms in a timely fashion, please be aware that at certain times of year we may receive dozens of school forms daily. Parents/Guardians are strongly advised not to wait until the last moment to request school medication forms for their children.


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