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Medical Statement Forms

The Nutrition Services Department will work to accommodate students who have medical conditions that require special nutritional & meal needs.  To provide this service, a copy of the Medical Statement to Request Special Meals and/or Accommodations form must be signed by a licensed physician, physician assistant, or nurse practitioner. 

 

If a student changes schools, Food and Nutrition Services must be notified. Please be sure that all forms are filled out in their entirety before sending them to the Nutrition Services department to ensure special diets are written and implemented in a timely manner. Special meal accommodations and milk substitution requests must be turned in every school year, they do not roll over from the previous school year.

 

To request a milk substitution due to a medical or other special dietary need, a parent or guardian can complete the "parental request for a fluid milk substitution for school-age children" form (provided below). Please note this form is not intended to accommodate students who drink fluid milk substitutions such as soy milk due to taste preference.

 

Once the form has been completed by a physician, it must be turned in to your school cafeteria. A copy of this form may be downloaded below.  

 

    • Medical Substitution Information for Parents

Form to request milk substitution(English) or (Español)

 

    • Special Diet Order Information for Parents

Form to request special meals: (English) or (Español)

 

If we do not receive a medical statement from a recognized medical authority, your child will receive a regular lunch meal.  Medical statements completed by parents or guardians will not be accepted.

Vegi Heart

 

"This institution is an equal opportunity provider"