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Health Forms

Please print each applicable form, complete, sign and return to the appropriate ECFS health office as indicated.

Please read the health information letter:
Health Forms Information Letter
ALL STUDENTS must submit a physical annually, signed by parent and physician. Due 8/13/12:
ECFS Physical and Immunization Form (2 pages) must be signed by parent & physician
Additional Health Forms (please submit if applicable):
Prescription Medication Form must be signed by parent & physician
Class Trip Medications Form must be signed by parent
Allergy Form must be signed by parent & physician
Asthma Form must be signed by parent & physician
Forms for New Students:
Eye Examination Form
(for new elementary students PreK-5th Grade)
must be signed by physician
Mantoux/TB Test Form
(for new middle and upper school students
who have not previously attended a NYC school)
must be signed by physician
Health Forms Packet:
This file includes all individual forms plus the health forms information letter
Health Forms Checklist:
Download a printable health forms checklist


Completed, signed forms can be scanned and sent via email.

Icon - Email 1  Email address for all health forms is healthforms@ecfs.org

Icon - Question  Please contact your division health office with any questions:

ETHICAL CULTURE
Nurse Sue Harrison

33 Central Park West
New York, NY 10023
Tel (212) 712-6265
Fax (212) 712-8444
FIELDSTON LOWER
Nurse Stacey Husted

3901 Fieldston Road
Bronx, NY 10471
Tel (718) 329-7292
Fax (718) 329-7304
FIELDSTON MIDDLE/UPPER
Nurses Eileen Coogan, Amy McNamara

3901 Fieldston Road
Bronx, NY 10471
Tel (718) 329-7276
Fax (718) 329-7346