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Physical Form for Students

Dear Parent/Guardian,
 
Good Health is important for learning. The NYC Public Health Code( Article 49.05) and the Department of Education Chancellor's Regulation ( A-701) require that all students entering public school for the first time have a completed medical examination.
 
To date, we do not have a completed physical exam on file for your child.  An updated exam is required after your Child's 5th birthday.
 
We strongly encourage you to schedule a visit with your Child's Doctor, and have the attached enclosed CH-205 completed and returned to us as soon as possible.
The completed form can be faxed to the school, at 718-894-3026, or emailed to the School Nurse Cindy Ciulla, RN at cciulla@schools.nyc.gov or Danielle Curry, PHADV- (Nurse's Asst.) at dcurry@health.nyc.gov.
Any questions please feel free to contact us between the hours of 8AM and 3PM at 718-326-2111.
 
Thank you for your cooperation.