Pennsylvania Department of Health

School Health Forms - Welcome

Welcome, and thank you for using the Division of School Health’s Online Stock Requisition Form!

Please take a moment to review the information below, as it may help to expedite the ordering process.

  • This form may only be used by Pennsylvania school nurses/personnel. The Division of School Health may not supply forms to any person or agency other than school entities located in Pennsylvania.
  • Please allow 4 – 6 weeks for processing and delivery when ordering health forms. If you do not receive your order within 4 – 6 weeks, DO NOT reorder! Call the Division to confirm receipt and obtain the current status.
  • Immunization cards must be ordered from the Division of Immunization at 717.787.5681. Nurses located in Philadelphia must request Immunization Cards from “The JFK Center” 215.875.3786.
  • Forms and manuals, not available for bulk order, are listed on their respective pages of the School Health website, www.health.state.pa.us/schoolhealth (ex. Hearing Screening Procedure Manual is now located on the School Health Screenings page under Hearing Screening). 
School District* (if not applicable, mark N/A)

County*

School Name*

Street Address 1* (No P.O. Box)

Street Address 2

City* (PA Only)

Zip Code* (i.e. 17000)

Name* (First and Last)

Phone Number* (i.e. 7175551212)

Email Address

NOTE: Order the number of forms required in increments of 50, not the number of packets.

Use only numbers. Do not use letters/words. If no forms are needed, leave blank.

School Health Record (2 page, back-to-back), 2013
Progress Notes, 2013
School/Private Report of Physical Examination, 2013
School Dental Record, 1999
Private Dentist Report of Dental Examination

Again, thank you for using our online Stock Requisition Form. If you have any questions or comments, please call us at 717.787.2390, or email to c-paschool@pa.gov.

Fields marked with an asterisk (*) are required.