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Click ‘Get Form’ to open the NYSED Interval Health History form in the editor.
Begin by entering the student’s name, date of birth, school name, age, and grade. Ensure all fields are filled accurately for proper identification.
Select the appropriate level of sports participation by checking the corresponding box (Modified, Freshman, JV, Varsity).
Indicate any limitations by selecting 'Yes' or 'No' and provide the date of the last health exam and when this form was completed.
In the health history section, answer each question regarding general health concerns, allergies, breathing issues, concussion history, devices/accommodations, family history, and gender-specific questions. Be thorough in your responses.
If you answered 'Yes' to any questions, provide detailed explanations in the space provided at the end of the form.
Finally, ensure that a parent or guardian signs and dates the form before submission.

Start filling out your NYSED Interval Health History form online for free today!

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2018	4.8 Satisfied (57 Votes)

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