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Medication Details
Confirmation of Medication Details you require to be administered by St Thomas' Catholic Primary School
Please ensure you have read the medication policy on the school website
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Email
*
Your email
Today's date
*
MM
/
DD
/
YYYY
Name of Pupil
*
Your answer
Class
*
Your answer
Name of Medication
*
Your answer
Dosage
*
Your answer
Brief explanation of reason medication is required and dates medication will be required
*
Your answer
Details of any allergies. (Take into account any cultural, religious or communication needs).
*
Your answer
Any other instructions ( eg if a tablet do they need it to be snapped in half)
Your answer
Time to be given (if more than once please tell us of each time it is needed)
*
Your answer
Your Name
*
Your answer
Relationship to child
*
Your answer
A copy of your responses will be emailed to the address you provided.
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