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New pupil Medical Questionnaire

Please note: It is a condition of acceptance at Bryanston that this form is competed by Friday 14 August at the latest - see Terms and Conditions 8a.

Sections with an * must be completed for the form to submit correctly.

Pupil details

If your child was born overseas, have they ever been registered with a doctor in the UK?*
Will your child be*

Immunisations

Please tell us if your child has had the following illnesses/immunisations with dates (please mark n/a if not applicable):

Major illnesses/injuries

Known allergies or drug sensitivities

Current medical treatment

If your child is currently undergoing any treatment or investigations please can you give us as much information as possible, including drug dosages, name/address of specialist, and arrangements for follow-up once at school. Letters from the specialist would be very helpful.

Does your child suffer from any of the following:

Asthma*
Hayfever*
Hearing problems*
Eyesight problems*

Family history

Additional information

Private health insurance and specialist referral

Is your child covered by private health insurance?*
If referral to a specialist is necessary, would you prefer this:*

Emergency contact details

We must be able to contact you, or someone who can make decisions about your child's health, at all times. Please provide contact details of someone who can make these decisions below.

New pupil medical examination

All pupils meet a school doctor in their first term at Bryanston, to discuss points arising from the New Pupils Medical Questionnaire, and for a brief medical check-up.

I give consent for the child named above to have a routine medical examination by the school doctor*

Confidentiality

Matters which pass between your child and the school doctor are treated in confidence, although every effort is made to include parents. There are two important exceptions:

1. A list is made available to school staff regarding pupils with ongoing medical conditions which may affect their well-being, safety or academic progress.
2. The School Medical team may disclose to a responsible member of the school staff, any matter which in his/her judgement seriously affects the well-being of a pupil, or of the school community as a whole.

I have read, and agree to, the above statement regarding confidentiality.*

Urgent treatment

We will make every reasonable effort to contact you should a medical urgency arise. In case we cannot contact you quickly enough, we must have your consent to your child receiving urgently needed treatment.

I give consent for my child named above to receive treatment which is, in the opinion of the School Medical Team, urgently necessary, including the administration of a local, general or other anaesthetic.*

"Over the counter" medicines and first aid

Please give your consent for your child to receive simple "over the counter" (non-prescription) remedies and First Aid at school. These may include Paracetamol, Ibuprofen (Nurofen), Cough Mixtures, Antihistamines and wound dressings.

I give consent for my child named above to receive non-prescription medIcines and First Aid at the discretion of the School Doctor or Nurse, or another responsible member of the school staff.*

Medication from overseas

Pupils living overseas must ensure that they bring only prescribed medication, licensed for use in the UK, back to school. Please give your consent for the School Doctor to prescribe a UK-equivalent for any medication that is found not to be licensed for use in the UK.

I give consent for my child named above to be prescribed as necessary (by the School Doctor) a UK-equivalent for any prescription medIcines my child may bring to School from outside the UK.*