Regarding the health inspection of children who start school, we request that you fill out this form with your child’s information and return it as soon as possible to the school nurse. The information supplied with the form is confidential, and it will not be disclosed to third parties by the health care department without your consent.
	
1. Family	Last and first names of the child
     	Personal identity number
     	
	Home address
     	
	Native language of the child
     	Language spoken at home
     	
	Name of the guardian 
     	Phone number
     	
	Name of the guardian
     	Phone number
     	
	Persons living in the same household as the child
     	
2. Pre-school period	Day care centre
     	
	Child health clinic
     	
	Your view on your child’s school readiness
     	
	Has your child’s school readiness been determined?

 No              Yes	Where?
     	
3. Future schoolwork	Thoughts on the commencement of schoolwork
     	
	How does your child travel to school?
     	
	Day/afternoon care arrangements
     	
4. Health routines	Child’s eating habits, special diets, etc.
     	Does your family eat together?
     	
	Child’s sleeping duration
     	Child’s daily screen time (TV, computer, video game consoles, etc.)
     	
	How does your family spend time together?
     	
	How does your child spend their free time?
     	
	Are there smokers in your family?
     	
	Is alcohol or other intoxicants used in your family?
     	
5. Health	Do you think that your child is healthy?
     	
	Does your child experience recurring headaches, stomach pain, sleeping difficulties, bedwetting, allergic reactions?
     	
	Does your child suffer from any long term diseases? Who is responsible for their treatment?
     	
	Medication needs, name of medication
     	
	Has your child received any rehabilitation? Such as speech therapy, occupational therapy, physical therapy, etc.
     	
6. Current situation of the pupil and the family 	What is your child good at?
     	
	What are the strengths of your family?
     	
	What do you feel you have been successful in?
     	
	Sometimes there are changes that the child and the family must go through, and those changes may bear significance to the successfulness of your child’s school career. Do you have any matters related to your family’s health and well-being you wish to discuss?
     	
7. 
Vaccinations	Will you allow your child to be vaccinated with basic and booster vaccinations at school? 

 Yes         No	
8. Signature	Place and time 

     	Guardian’s signature 

     	
9. School nurse	Name and phone number 
     	

Thank you!