Physician Health Form | Charlottesville Day School

Health Form and COVID Vaccine Card

1. Please print and fill out Page 1 of this form: Commonwealth of Virginia School Entrance Health Form
2. After filling out page 1 of the form completely, please scan the document as a PDF and upload it to this form.
3. Have your child's physician fill out the remaining pages and use the Physician Health Form to upload their document.
4. If your child is fully vaccinated for COVID you may upload your vaccine card here.

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PDF of page 1 of Commonwealth of Virgina School Entrance Health Form*

Accepted file types: pdf, Max. file size: 50 MB.