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High School Nurse Visit Request
Nurse E-Pass
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* Indicates required question
Email
*
Your email
Student Name
*
Your answer
Student Grade Level
*
Freshman
Sophomore
Junior
Senior
Symptoms
*
Cold
Sore Throat
Cough
Rash
Injury
Teeth
Eyes
Ears
Headache
Stomach
Other
Emergency
Required
If "other" , "injury", or "emergency" is checked please briefly describe
Your answer
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