Consent for Communication and Information Sharing Between School and Health Care Teams

Caregivers can use this form to give your permission to allow your child's school and doctor to talk to each other about your child's health and school progress. When you sign the FERPA consent (Section 1) school staff can share information with your child's healthcare team, and when you sign the HIPAA Consent (Section 2), health care providers can share health information with the school. 

This helps everyone work together to support your child's health and learning. You can cancel this permission at any time. This teamwork between school and healthcare providers helps your child get the right support both at school and during medical visits. Be sure to fill out both sections if you want the communication to flow both ways. 

Fill out this form and send it to your school or your health care provider's office to get started!