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BONITA SPRINGS: 239-495-0045
FT. MYERS: 239-466-6646
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Get Pricing & Details Now
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BONITA SPRINGS:
239-495-0045
FT. MYERS:
239-466-6646
CALL NOW
BONITA SPRINGS:
239-495-0045
FT. MYERS:
239-466-6646
Programs
Infant
Toddlers
2s, 3s and 4s
Voluntary Pre-K
School Age
Summer Camp
About
About Us
Why Choose Us
Careers
Reviews
Tuition Support
Careers
Locations
Bonita Springs, Florida
Fort Myers, Florida
For Our Parents
Parent Portal
Blog
Contact Us
Menu
Programs
Infant
Toddlers
2s, 3s and 4s
Voluntary Pre-K
School Age
Summer Camp
About
About Us
Why Choose Us
Careers
Reviews
Tuition Support
Careers
Locations
Bonita Springs, Florida
Fort Myers, Florida
For Our Parents
Parent Portal
Blog
Contact Us
Programs
Infant
Toddlers
2s, 3s and 4s
Voluntary Pre-K
School Age
Summer Camp
About
About Us
Why Choose Us
Careers
Reviews
Tuition Support
Careers
Locations
Bonita Springs, Florida
Fort Myers, Florida
For Our Parents
Parent Portal
Blog
Contact Us
Menu
Programs
Infant
Toddlers
2s, 3s and 4s
Voluntary Pre-K
School Age
Summer Camp
About
About Us
Why Choose Us
Careers
Reviews
Tuition Support
Careers
Locations
Bonita Springs, Florida
Fort Myers, Florida
For Our Parents
Parent Portal
Blog
Contact Us
Medication Authorization/Modification Form
Location?
(Required)
Fort Myers, FL
Bonita Springs, FL
Medication Authorization/Modification Form
Select One:
Medication Authorization
Medication Modification
Medication Di:scontinuation
Effective Date:
Month
Day
Year
Child's Name:
Medication Name:
Dosage Amount:
Time to be Given:
Date(s) to be Given:
Side Effects/Anticipated Reactions:
Special Instructions/Circumstances for Administrating "as needed" medication:
Parent's Signature
Date
Month
Day
Year
Please note the following requirements, if not followed, will result in medication not given.
Medication MUST be in its original container.
Medication must bear a printed label clearly stating the name of the child to whom the medication has been, prescribed.
All information above MUST be completed.
Medication Authorization/Modification Form to be updated, by parents, as changes occur or at least every three months.
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BRANFORD –
203-488-5437
CHESHIRE –
203-271-1147
WALLINGFORD –
203-269-5437