Montgomery County School Based Health

School Year 2026 - 2027
 

Consent for School Entry Physical Exam

The school requires Kindergarten, 6th Grade, and any new out of state student to have an entry Physical Exam. The Nurse Practitioner can complete the exam if you want to get your child’s exam at the school clinic.  All you need to do is check below giving permission if you would like us to complete your child’s School Entry Physical Exam. 

If your child has already had a physical exam or the required school check-up at their primary care physician’s office, please forward a copy of it to the school as soon as possible. 

Yes, I would like for Sterling Health Care, Inc. to complete my child’s physical at school.
No, my child has already had their required physical exam.

                                                                                   Consent for Well-Child Exam

As part of overall health care for children, it is recommended that all children have a Well-Child Exam on a yearly basis. The Nurse Practitioner can complete the exam if you want to get your child’s check-up at the school clinic. All you need to do is check below giving permission if you would like us to complete your child’s Well-Child Exam. 

If your child has already had a well-child exam or the required school check-up at their primary care physician’s office, please forward a copy of it to the school as soon as possible. Well-Child exams are billable and will be billed to your insurance/medical card. Although, for private insurance NO COPAY will be billed to you because the children's Well-Child Exams are covered 100% by insurance, it will be NO COST to you.

All exams can be completed at the school clinic and will include required immunizations (shots) because SHC is now able to bring the vaccines to school. If your child needs a physical that requires a vaccination, we will coordinate this with you by sending an additional Vaccine Consent home listing the vaccinations needed for your child to be up to date on immunizations.

Yes, I would like for Sterling Health Care, Inc. to complete my child’s exam at school.
No, my child has already had their yearly Well-Child exam.

Student Information

School  Montgomery County Middle SchoolJ.B. McNabb Middle SchoolCamargo Elementary SchoolMapleton Elementary SchoolMount Sterling Elementary SchoolNorthview Elementary School

First Name      Middle Name      Last Name

SSN     Birthdate

Parent / Guardian Information