Forms

School Entrance Health Form Instructions Virginia Department of Health, Revised April 2007.

School Entrance Health Form-MCH-213F

Certificate of Religious Exemption

Virginia Department of Health, Revised April 2007. Official color of the School Health Form is white.

Download and print school entrance health form and instructions as needed or how to order the School Entrance Form-MCH-213F (04/07):

If you are a public or private school K-12, your contact for ordering forms is:

Kim Jefferson
Phone: 804-864-7685
Fax: 804-864-7722
Email: Kim.Jefferson@vdh.virginia.gov

If you are a clinic, doctor's office, preschool, or childcare center, your contact is:

Willie Cannon
Phone: 804-864-8055
Fax: 804-864-8089
Email: Willie.Cannon@vdh.virginia.gov

Please order the number of forms that you anticipate you will use in the next few months. We request that you do not stockpile the forms, as they will be updated periodically to reflect changes in Virginia's laws.

There is a limit of 4 packs (50 copies per pack) per order. If you need additional forms, please contact Kim or Willie with your justification of need.

When ordering, please include the following information:
Name of contact:
Phone number of contact:
Name of Facility:
Mailing street address:
Number of packs (50 forms to a pack): Please allow 3-5 working days for your order to be processed.

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