Click the name of the form you would like to download.
This document includes all forms which are required for a student to be seen at the Lonoke Baptist Health Clinic; the Demographics Form, Consent Form, History Form, Clinic Screener, & COVID-19 Questionaire.
Remember, the Consent Form and the History Form both require signatures. If these forms are not signed by a parent/guardian, a student cannot be seen at the Lonoke Baptist Health Clinic.
The demographics form must be filled out for a student to be seen at the Lonoke Baptist Health Clinic.
The Consent Form must have a parent's signature. All 5 pages must be returned with the last page signed.
The History Form requires a parent's signature for a student to be seen at the clinic.
The clinic screener should be filled out for each visit to the clinic. This allows the medical staff to gather information about current illnesses or concerns.
The COVID-19 Questionaire should be returned with all other forms before a student can be seen at the clinic.
