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Physical Forms

Well Child Exams & School Sports Physicals


Well Child Exams

Being proactive plays a key role in maintaining wellness throughout life. Yearly Well Child Exams are the best way to ensure your child stays on track in growth and development and receives vaccinations on schedule (as determined by your child's provider and standardized guidelines). Call 402.372.2404 today to set up your child's appointment.



2023 School Physicals

May 19, 2023

Dear Athletic Directors, Principals, and Parents,

To participate in Nebraska School Activities Association (NSAA) activities for the 2023-2024 school year, an NSAA sports physical form will need to be completed.  Franciscan Healthcare has put together a packet of information for parents to help set up a wellness exam and have the NSAA sports physical form completed.  This packet includes NSAA form, immunization information and consent, consent to treat, and a checklist to help the process. We would encourage all students to have a wellness exam. Please contact the Franciscan Healthcare at 402.372.2404 to schedule your appointment.

The NSAA physical forms are available on our website, at the school, or at the clinic.

Bring completed History Form. A consent form needs to be signed for the clinic to perform the physical. 

Bring a first morning urine sample. To prevent unnecessary rechecking of urine, drink plenty of fluid 48 hours before the sample is taken.

The student must bring their immunization records. This is an excellent time to get caught up on immunizations. Common immunizations include Tetanus (includes pertussis for whooping cough), meningitis, and human papilloma virus (HPV). Sign consent form if unable to accompany child to appointment.

Students who wear glasses or contacts need to bring/wear them to the appointment for the eye exam.

Please speak with us or stop in to clarify any information or to pick up any necessary forms.

At the end of each physical the student will be given a “Consent to Participate” and Physical form. Because of HIPAA, the parent decides what information will be shared with the schools beyond the consent form. We strongly encourage parents to share the entire physical form with the school in the interest of the health of their child. Particularly if your child has health concerns that the school nurse and/or coaches should be aware of.

Have a great 2023-2024 school year!



The Medical Staff of Franciscan Healthcare



Click on Downloadable Forms Below: