Student Health Questionnaire 2026/27

Initial Health Questionnaire
Student Name

First NameLast Name
ISM Year Group
Class if known
All medical information provided will be inputted into the school digital storage software, ‘Engage’. The digital files are well secured and only staff directly involved have access. The medical information will be shared with your child’s teachers, wellbeing staff and learning support staff on a need to know basis.

If your child has a long term medical condition which requires specific management, an Individualised Health Care Plan (locally referred to as a Projet D’accueil Individualisé or ‘PAI’) may need to be put in place in collaboration with yourselves, the Health Centre team and your child’s Doctor. Please contact the Health Centre directly by email at Healthcentre@ismonaco.com to discuss this process further if you think that this may be required.

Does your child live with any of the following allergies? Yes/No

Rows	Yes	No
Food allergies (requiring medical treatment in the event of a reaction)
Medication allergies
Environmental allergies (Including insect stings, pollen, animals, dust, grasses or allergies to cleaning products etc)

If you answered yes to any of the questions above, please provide details of the type of allergy, reaction and treatment protocol.
Does your child experience any food intolerances or have any specific dietary requirements? (Please note that for our school kitchen to be able to provide alternative options, we will require a medical certificate or food testing documentation in either French or English completed by a France or Monaco based Doctor)
Allergy/Dietary Supporting Documentation

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Does your child take prescribed medications on a regular basis? Please list medication, dose and purpose.
It is school policy that no student may carry on their person or in their bag any medication on school premises for safety reasons. Medications will be kept securely in one of the designated Health Centres and students may have access to these when required.

Any medication that needs to be taken during school hours or on school trips must be reviewed and stored with the Health Centre team and be provided as detailed below:

• The doctor’s prescription for each course of medication. Written by a France or Monaco based Doctor in either French or English, stating the name of the student, the medication, the dose, the frequency, the duration if short term, signed by the Doctor.

• The medication provided by the parents in its original container, within the expiry date.

• Completed administration of medications consent form signed by the parents.

Please see the Administration of Medicines and Managing Medical Conditions at School Policies for further information.

Non-prescription medication permission: Should the need arise, the Health Centres have a stock of age appropriate over-the-counter medications available to the students during the school day or on a school organised trip (following a clinical assessment) if parental consent is marked. Parents/guardians will be notified of the date and time of administration of any oral medications. For students in the Primary Years School, parents/guardians will be contacted by phone for additional verbal consent before any oral medication is given to confirm the time and dose of any previous medicines given.

Rows	Yes	No	Unknown
Chicken Pox
Measles
Mumps
German Measles/Rubella
Meningitis

Rows	Yes	No
Asthma
Diabetes
Headaches/Migraines
Heart Condition
Has your child had any recent injuries/surgeries or broken bones
Ocular conditions or eyesight concerns
Has your child ever had an educational or clinical psychologist's assessment?
Has your child experienced any mental health challenges?
Does your child receive any support for speech and language development?
Does your child have any motor development difficulties?
Any other health conditions

Rows	Yes	No
Arnica gel (bruises)
Apaisyl (insect bites)
Chlorhexidine (antiseptic spray)
Gaviscon (anti-reflux solution, only for 12+)
Osmo soft gel (burns)
Paracetamol (pain or fever, dose based on weight and age as per manufacturer's guidelines)
Spasfon (stomach or menstrual cramps as per manufactuer's guidelines)
Strepsil (medicated throat lozenge, only for 6+)

Initial Health Questionnaire