Student health exam, immunization information for parents and guardians

As of July 1, 2018 New York State law requires a health examination for all students entering the school district for the first time and also when entering Pre-K or K, 1st, 3rd, 5th, 7th, 9th , and 11th grade.


The examination must be completed by a New York State licensed physician, physician assistant or nurse practitioner and on the approved NYSED Student Health Examination Form for School. The physical form is available on the district website. As of this mailing, the Department of Health WILL NOT be providing a grace period for physicals and immunizations. Students must be up to date by the opening of school.

A dental certificate, which states your child has been seen by a dentist or dental hygienist, is also asked for at the same time. The school will provide you with a list of dentists and registered dental hygienists who offer dental
services on a free or reduced cost basis if you ask for it.

  • A copy of the health examination must be provided to the school within 30 days from when your child first starts at the school, and when your child starts K , 1st , 3rd, 5th, 7th, 9th, & 11th grades. If a copy is not given to the school within 30 days, the school will contact you.
  • If your child has an appointment for an exam during this school year that is after the first 30 days of school, please notify the Health Office with the date.
  • For your convenience, a physical exam form and dental certificate are linked here.
  • Communication between private and school health staff is important for safe and effective care at school. Your healthcare provider may not share health information with school health staff without your signed permission. Please
    talk to your provider about signing their consent form for the school at the time of your child’s appointment for the examination.

We suggest you make copies of the completed forms for your own records before sending them to the school health office. Forms may also be faxed to your child’s school health office.

Click here for the immunization requirements for all students.

Pine Bush School District Nurses


Marybeth Reinfried, Jill Gribbin – Pine Bush High School 845-744-2031 x 3610
Fax: 845-744-4094

Diane Tjornhom – Crispell Middle School 845-744-2031 ext. 4410
Fax: 845-744-4074

Linda Loennecker – Circleville Middle School 845-744-2031 ext. 5610
Fax: 845-744-4076

Laura Stein – Circleville Elementary School 845-744-2031 ext. 5510
Fax: 845-744-4075

Patricia Fernandez – Pakanasink Elementary School 845-744-2031 ext. 5710
Fax: 845-744-4077

Vicki LaRosa – Pine Bush Elementary School 845-744-2031 ext. 4310
Fax: 845-744-4073

Patricia Soutar – EJ Russell Elementary School 845-744-2031 ext. 4210
Fax: 845-744-4072

Pine Bush Central School District
State Route 302, Pine Bush, NY 12566
Phone: (845) 744-2031
Fax: (845) 744-6189
Tim O. Mains
Superintendent of Schools
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