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Health Office Form

Welcome to Manchester Regional High School's

Virtual Nurse's Office

IR school nurse

Ms. Irique Robinson

Passaic County Manchester Regional High School students, staff, and parents have the oppurtunity to virtually meet the school nurse Ms. Irique Robinson for advice on personal medical-related questions or concerns during school hours:

Monday - Friday 8:00am - 3:00pm.

External links

COVID-19 Mobile Testing Site November

Please fill out the following contact information to schedule an apointment with the MRHS Health office.

Once the form is submited you will recieved an email from "[email protected]" to book your Virtual Health Office Appointment.

(Fields with * are required)

Student ID Number*

Answer required for "Student ID Number"

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Manchester Email Address

Answer required for "Manchester Email Address"

Parent or Guardian Email Address

Answer required for "Parent or Guardian Email Address"

Mobile Phone*

Number Required

Home Phone

Number Required

Work Phone

Number Required

Preferred Method of Contact*

Answer required for "Preferred Method of Contact"

Student Email

Parent or Guardian Email

Mobile Phone

Home Phone

Work Phone

Briefly describe your reason for the appointment: *

Answer required for "Briefly describe your reason for the appointment: "

Please Upload any Necessary Documents. (Keep?)

Answer required for "Please Upload any Necessary Documents. (Keep?) "

Choose a file or drag it here.

Confirmation Email

Confirmation Email *

Answer required for "Confirmation Email"