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CLOSER PUBLIC SCHOOLS CLOSER, NEW JERSEY 07624 HEALTH INFORMATION Part 1: PARENT OR LEGAL GUARDIAN TO COMPLETE Students Name: (Last)(First)(M.I.)(Grade) Students Date of Birth: Sex: () M () F State
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Start with the personal information section and enter your full name, date of birth, gender, and contact details.
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Move on to the medical history section and provide accurate information about any previous illnesses, allergies, surgeries, or chronic conditions you have experienced.
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Fill in the information regarding any current medications you are taking, including the dosage and frequency.
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If applicable, provide details about your family medical history, such as any genetic diseases or medical conditions that run in your family.
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Answer the questions related to your lifestyle, including your diet, exercise routine, smoking/drinking habits, and any additional relevant information.
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Review all the entered information to ensure it is accurate and complete.
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Save the filled-out form and submit it to the appropriate healthcare provider as instructed.

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