The following forms should be completed by you and your child’s health care provider.
The Questionnaire for Parents of a Student with Seizures should be completed by a parent/guardian.
The Seizure Action Plan should be completed by you and your child’s physician.
These forms will assist us in providing the best possible care for your child at school. Your child’s health care provider will be able to share pertinent information with the clinic staff to better manage your child’s symptoms. After the paperwork has been completed, please return it to the campus clinic. We will accept alternate forms from your child’s physician if they prefer to use their own. Please make sure any alternate forms include all of the same information as the forms Pleasanton ISD has provided. Please bring your child’s current medications with the completed forms to the clinic office. A new form must be completed each school year.
Please see the following links for helpful information and resources on seizures.
For information regarding Diastat, click here.
For a free and easy way to track seizures, click here.