The required forms can be scanned and emailed to health@scattergood.org or physical copies can be mailed to Scattergood Friends School ATTN: Health Office, 1951 Delta Avenue, West Branch, IA 52358.

Once your forms are submitted you will receive an approval email from the Health Office. Students are not ready to move in until all applicable forms are submitted and approved by Scattergood.

Health Office Enrollment Forms:

  • Student Information and Health History

  • Consent to Treat

  • Insurance Form – Students are required to have health insurance to attend Scattergood. If your student is an international student, please contact business@scattergood.org for information about International Student Health Insurance. If your student has out of state Medicaid, consider applying them for Iowa Medicaid or notifying your state’s Medicaid office that your student will be out of state for a facility stay in order to expand your coverage to our area.

  • Iowa State Certificate of Immunizations or State Medical/Religious Immunization Exemption Form

  • Iowa State Dental Certificate* – 9th grade only

  • Annual Physical*

  • Concussion Form

  • Over the Counter Medications

  • Medication Permission Form* – All If your student takes prescription medications, be sure they are set up through the Towncrest Pharmacy along with current insurance information. If your student takes multiple medications you must set up Multi-Dose Pill Packaging. For more information about this service please reach out to Towncrest Pharmacy at 319-337-3526

  • Mental Health Action Plan*

  • Allergy Action Plan*

  • Asthma Action Plan*

  • Authorization to Self Administer Medication* – If your student would like to carry their own inhaler or Epipen, this form must be completed with their physician. If not completed, all medications must be kept in the Health Office.

*Please note these forms require a physician’s signature.

Forms such as the Mental Health Action Plan, Allergy Action Plan, Asthma Action Plan, Authorization to Self Administer Medication are conditional and only required for students who currently or have ever experienced these conditions. If your student does not currently experience these but has in the past, please complete the form to better help us support your students’ health needs.