There is no single federal Head Start physical examination form. Each local program picks what it accepts — a state health assessment form, a template the program built, or standard well-child visit documentation from your pediatrician. What federal law does require, under 45 CFR § 1302.42, is that within 90 calendar days of your child’s first day of attendance the program have on file a determination from a health care professional that your child is up to date on preventive and primary medical care.1eCFR. 45 CFR 1302.42 – Child Health Status and Care So the first move is not the doctor’s office. It’s a call to your program.
Ask Your Program Which Form to Use
Contact the local Head Start office and ask which physical examination form they accept. Some programs hand parents a specific document at enrollment. Others accept any well-child visit summary as long as it covers the required screenings. Head Start’s own oral health guidance confirms this flexibility, noting that programs may use “any form that works best for their program, either the forms provided here, state-mandated forms, or their own forms,” and the same principle applies to the physical.2HeadStart.gov. Head Start Oral Health Forms
If the program gives you a specific form, bring it to the appointment. If the program accepts general documentation, ask the pediatrician’s office for a copy of the most recent well-child visit summary and confirm it includes every item listed below. Either way, sort this out before you schedule. Showing up without the right paperwork is the most common reason parents end up making a second trip.
What the Exam Has to Cover
The regulation ties Head Start’s medical requirement to the EPSDT periodicity schedule used by your state’s Medicaid agency.1eCFR. 45 CFR 1302.42 – Child Health Status and Care EPSDT well-child visits include five core components: a comprehensive health and developmental history, an unclothed physical examination, age-appropriate immunizations, laboratory tests, and health education.3Medicaid and CHIP Payment and Access Commission. EPSDT in Medicaid
In practice, the provider will record height, weight, and BMI percentile, and check blood pressure (typically beginning at age three). Lab work usually includes a hemoglobin or hematocrit test to screen for anemia and a blood lead level test. Head Start programs are required to partner with families and providers to make sure children receive lead screening in line with the CMS universal blood lead screening requirement for Medicaid-eligible children.4HeadStart.gov. The Role of Head Start Programs in Addressing Lead in Water The provider should also assess tuberculosis risk, following the EPSDT schedule and any additional recommendations from the program’s local Health Services Advisory Committee.5HeadStart.gov. Tuberculosis
Immunizations
The form (or a separate immunization record) must show your child is current on the vaccination schedule recommended by the Centers for Disease Control and Prevention.1eCFR. 45 CFR 1302.42 – Child Health Status and Care For children entering a typical program at age three or four, this generally includes DTaP, polio, MMR, hepatitis B, varicella, and other vaccines on the CDC’s childhood schedule. The provider should list the dates each dose was given.
If your child is missing doses, the program is required to help you arrange catch-up shots quickly. Exemptions — medical or religious — are governed by state law, not by federal Head Start rules. Ask the program coordinator which exemption forms your state recognizes and how to submit them.
Cost
Most children eligible for Head Start also qualify for Medicaid or CHIP, which cover EPSDT well-child visits and the associated screenings at no cost. If your child is uninsured, ask the coordinator about coverage options. The regulation allows programs to use their own funds for medical services “when no other source of funding is available.”1eCFR. 45 CFR 1302.42 – Child Health Status and Care
Vision, Hearing, and Dental
Two things the physical exam form may or may not cover: vision and hearing. Programs must obtain or perform evidence-based vision and hearing screenings within 45 calendar days of the child’s first day, a tighter window than the 90 days allowed for the full health assessment.6HeadStart.gov. Vision Screening for Young Children For home-based options, the clock runs from the first home visit. Programs operating 90 days or less have 30 days.
Some pediatricians include basic vision and hearing checks in the well-child exam, which can satisfy the requirement. Others don’t, and the program does its own screenings on-site. Confirm which applies before the appointment. If your child wears glasses or hearing aids, bring the prescription and any specialist reports.
Then there’s dental. The same 90-day regulation requires a separate determination from an “oral health care professional” that your child is current on preventive dental care.1eCFR. 45 CFR 1302.42 – Child Health Status and Care The physical exam form does not satisfy this. Schedule the dental visit at the same time you schedule the physical, so both deadlines get covered together.
Completing the Parent and Provider Sections
Most physical exam forms have two parts. You fill in the top: your child’s full legal name, date of birth, known allergies, current medications, and relevant family medical history. Double-check the spelling of your child’s name against the enrollment paperwork. Mismatches create delays.
The clinical section is for a licensed health care professional. The federal regulation refers broadly to “health care professionals,” which in practice means physicians, nurse practitioners, and physician assistants — anyone authorized under state law to perform a pediatric well-child examination. The provider records exam findings, screening results, and lab values, then signs and dates the form.
A missing provider signature is the single most common reason forms come back. Before you leave the office, flip to the signature line and check it yourself.
If your child had a well-child visit recently, the provider can often use those results to complete the form rather than repeating the exam, as long as the visit falls within the timeframe your program accepts. Many programs require the exam to have occurred within the past 12 months. Confirm with your coordinator.
Turning the Form In
Once signed, return the form to your program coordinator. Submission options vary:
- In person at the local Head Start office. This is the fastest way to confirm receipt and fix any missing information on the spot.
- Through a secure parent portal, if the program offers one. You upload a scan or clear photo of the completed form.
- By mail, using a method that provides delivery confirmation. Health records are sensitive documents and you want proof they arrived.
After submission, the coordinator reviews the form for completeness and confirms receipt by phone or email. If something is missing — a signature, a lab result, a vaccination date — the coordinator will contact you. Respond quickly. Every day counts against the 90-day deadline.
The Three Deadlines Running From Day One
All health deadlines run from your child’s first day of attendance (or first home visit for home-based programs):
- 30 days: the program must consult with you to confirm your child has an ongoing source of health care and health insurance coverage.1eCFR. 45 CFR 1302.42 – Child Health Status and Care
- 45 days: vision and hearing screenings must be completed or obtained. Developmental screenings covering social, cognitive, and emotional skills must also be done within this window.7HeadStart.gov. Child Screenings and Assessments
- 90 days: the program must have on file a determination from a health care professional that your child is up to date on medical and oral health care, including immunizations.1eCFR. 45 CFR 1302.42 – Child Health Status and Care
Programs that operate for 90 days or less compress all of these deadlines to 30 days from the child’s start date.8eCFR. 45 CFR 1302.42 – Child Health Status and Care If you’re enrolling in a summer program, book the physical and dental appointments before the first day. There won’t be time to arrange them afterward.
Food Allergies and Special Health Needs
If your child has a food allergy, the physical exam form alone will not cover what the program needs. Head Start requires a separate care plan prepared by your child’s health care provider that includes a written list of allergens, steps to avoid exposure, and a detailed treatment plan with medication names, doses, and administration methods.9Head Start. Caring for Children with Food Allergies The plan must also describe which symptoms would trigger medication use. For children at risk of anaphylaxis, staff are trained to call 911 and follow the care plan, and must contact emergency services even if the child responds well to epinephrine.
Note any allergies, chronic conditions, or special dietary needs on the physical exam form itself, and raise them separately with the coordinator. The more the program knows before day one, the better prepared staff are.
When a Screening Turns Up a Problem
If the exam or a program screening flags something — elevated lead levels, abnormal vision or hearing, a possible developmental concern — the program is required to facilitate further diagnostic testing, evaluation, and treatment by a licensed professional.8eCFR. 45 CFR 1302.42 – Child Health Status and Care The program must also track referrals, monitor whether follow-up is happening, and help you obtain prescribed medications, aids, or equipment.
If the provider marked any referrals or follow-up needs on the physical exam form, point those out to the coordinator when you submit it. That’s what gets the follow-up work started.
You can find your nearest program through the Head Start Center Locator at headstart.gov/center-locator.