Health Forms

Health Forms for School Year 2022-2023

In an effort to better meet the needs of individuals turning in state required health forms, MTHS is offering four options.  The preferred method is electronic submission via a secure email directly to the school nurse at  This process can be done by scanning or taking a picture of the documents on a smartphone and then emailing the forms to the email address listed above.  Forms may also be faxed to the school nurse’s dedicated fax line at (309)-367-4251, dropped off at the school office Monday – Thursday (7:30am-12:30pm) or mailed to the school marked Attention “Nurse Doty”.  ALL pages must display the student’s full name and date of birth in order to be valid.  

The forms normally collected by Health Services each year, along with comments and links to the forms, are listed below.  Physicals and immunization records are due by the first day of school.   


All incoming freshman and transfer students MUST have a completed Department of Human Services Physical Form on file.  This form has a required “Health History” section that parents or guardians need to complete, sign and date prior to submission.  DHS Physicals can be used as a sports physical, BUT a sports physical cannot be used as freshman or transferring student’s entrance physical.  

Immunization Record

All incoming freshmen MUST submit an up-to-date immunization record.  More information on ISBE Immunization Requirements can be found on the ISBE website.  Seniors need to show proof of receiving the meningococcal vaccine.  

Religious Exemption Form

Medication Administration Form

Students requiring prescription medications while at school must have a Prescription Medication Form completed/signed by a Healthcare Provider.  The parent section must also be signed and dated.  

Over the Counter Medication Form (Ibuprofen or Acetaminophen) 

In order for a student to receive ibuprofen or acetaminophen form the nurse, the Non-Prescription Medication form must be on file. 

Medical Concern Form

If your child has a medical concern that you would like shared with the school nurse, please fill out the Medical Conditions form.