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Food Allergy Form and Information

Please follow the instructions listed below to notify the school district if your student has a food allergy:

  • Print the Medical Statement for food allergies form listed below.
  • Have a physician, M.D. or D.O., fill out the form completely and sign as well as parent signature.
  • Return to the nurse at the school your student will be attending.*

*The form must be filled out again by a physician for any change to the student’s allergy status.

Food allergy form

Food allergy policy

Food allergy information  -  www.theicn.org

* New direction from DESE and the USDA:  If a food item is processed in a facility that also processes other items that contain allergens, that food item will now be considered to have those additional allergens.