By Jennifer Fernandez
Even as one school year is wrapping up, parents of preschoolers should be working on getting their kindergarten students ready for school in the fall.
A key recommendation: Schedule a well-child visit and ask your child’s doctor to fill out the North Carolina Health Assessment Transmittal Form, a health assessment document that becomes part of a child’s school record.
State law requires that all children receive a health assessment before entering school for the first time. For most students, the first time through the schoolhouse door is kindergarten. (Pre-K students aren’t required to submit this health assessment. They have a separate form to fill out and different immunization requirements.)
About 100,000 children enter kindergarten annually in North Carolina, according to state data on public school enrollment.
In some schools, as many as 40 percent of incoming kindergarten students have not submitted the required forms within the first 30 days of enrollment, Victoria Witherspoon, a kindergarten transition specialist with Guilford County Schools, told NC Health News.
Not submitting those forms puts students in jeopardy of being sent home until the assessment or immunization records are submitted, health and school officials said.
“The schools are doing as best they can do,” said Dave Tayloe of Goldsboro Pediatrics in Wayne County.
Tayloe, a pediatrician for more than 50 years, said families sometimes struggle to squeeze in the appointment before school starts. Every fall, he’ll hear from school officials about the backlog of students needing assessments.
“We’ve scheduled doctors on extra days to take care of them,” he said.
What’s in the health assessment?
The two-page health assessment form allows providers to share information on prescribed medications, allergies, dietary needs and health-related recommendations “to enhance the student’s school performance.” There are also spots to confirm if a student has passed vision and hearing screenings and whether any school follow-up is needed. The form also includes contact information for the family and the provider.
One section indicates whether other school health forms — immunization records, medication authorizations, and care plans for diabetes, asthma or other health conditions — are attached.
Children can get the assessment, which has been required since the 2016-17 school year, through their doctor or at local health departments. Parents can also take children to an urgent care facility to get the health assessment completed and to a pharmacy for immunizations. Community health centers such as Triad Adult and Pediatric Medicine in Guilford County are also an option.
To find a community health center near you, enter your ZIP code at this website, or fill in the form below:
Students entering NC Pre-K must also complete a dental screening.
“We really go over these kids carefully,” Tayloe said. “We’ve worked on that form with the Pediatric Society since the early ’80s.”
School systems warn parents that children who do not submit completed forms by the 30th day of school will not be permitted to stay in class.
The North Carolina Department of Health and Human Services “works with city, county and state partners to try and help schools come into compliance,” state health officials told NC Health News in an email. However, NC DHHS “does not have authority over school compliance.”
In its Let’s Get Ready! Guide, the North Carolina Department of Public Instruction suggests parents with new kindergartners set up a well-child visit between November and January before the child enrolls. Parents should ask their health care provider to fill out the required health assessment, make sure vaccinations are up to date and get a copy of their child’s immunization record, DPI said.
Each school district engages in outreach to get children ready. For instance, Guilford County Schools launches its kindergarten registration efforts in January of each year. The district holds a resource fair where kids can get immunizations and complete their health assessment. Families can learn about the requirements and set up pediatrician appointments during “Discover Kindergarten” events at the children’s museums in Greensboro and High Point. Parents of incoming kindergartners are invited to elementary schools to talk about preparing their children for school.
Outreach goes beyond the health assessments and immunizations. Parents can sign up for transportation and learn what they can do with their children over the summer to prepare.
“We really think about kindergarten transition as almost like a yearlong or eight-month-long process where we’re connecting with families to really inform and empower and engage them,” said Amy Geer, director of early learning and school readiness for Guilford County Schools.
Nonetheless, some families struggle to fill out the forms before school starts.
Barriers to care
Tayloe said several factors may be driving delays in getting the assessments.
Parents may be working or lack ready access to transportation, he said. DHHS noted that other barriers include limited clinic hours, lack of health care coverage and too few providers or provider appointments.
Within the 946 square miles of rural Sampson County, for example, there are two pediatricians, according to data compiled by Cecil G. Sheps Center for Health Services Research at UNC Chapel Hill.
Sampson County Schools enrolled 560 kindergarten students for the 2025-26 academic year, state data shows.
Across North Carolina, 19 counties have no pediatricians, according to Sheps Center data. Only nine counties have two or more pediatricians per 10,000 residents.
The number of pediatricians in the state has been growing, but not enough to fill existing coverage gaps or keep up with population growth.
The state added just 113 pediatricians from 2013 to 2024, even as the state’s population grew by more than a million people. During that same time period, the rate of pediatricians slipped from 1.65 doctors per 10,000 population to 1.58 doctors per 10,000 population, data show.
Even when parents know they have to get the assessment, they have to figure out where to get it done and when and where to get required immunizations, Geer said. They have to schedule appointments, figure out transportation and then make sure to get the forms to their child’s school.
Language can also be a big barrier. In Guilford County Schools, the third-largest school district in the state, students come from more than 142 cultural and ethnic groups and speak 118 languages — from Arabic and French to Spanish and Urdu.
“We have a lot of families that are coming from other countries that this wasn’t a part of their … norm,” Geer said. “And so I think that’s a big barrier, too, especially here in Greensboro.”
Focus on kindergarten transition
Witherspoon is one of two kindergarten transition specialists in Guilford County Schools. The district plans to hire two more this summer. The position is fairly new as the district homes in on how to best prepare new students for kindergarten.
They’ve been working since November 2024 in the highest-needs schools. Witherspoon works at Bessemer, Cone and Rankin elementary schools in the east and northeast areas of Greensboro. More than 78 percent of students at each school are considered economically disadvantaged. That’s much higher than the 56 percent of students districtwide who qualify for free or reduced-price meals.
In Greensboro, the kindergarten transition team is funded through a grant from Ready for School, Ready for Life. The Greensboro nonprofit is considered a “backbone” organization that provides support for programs and other organizations in the community focused on preparing young children to succeed in school.
Geer said many school districts across the state are starting to focus on kindergarten preparation earlier.
Guilford County Schools works closely with the Guilford County Department of Public Health, which often extends clinic hours at the beginning of school to help families get needed vaccinations or fill out the health assessment, said Deirdre “Dee” Moyer, the school district’s director of health services. The health department also schedules immunization clinics at schools.
The county health department recently reached out to providers to encourage them to remind parents to get the health assessment filled out when their child comes in for a regular visit.
If a child has had a physical within the past year, parents can take the health assessment to the doctor’s office to be filled out and signed by the doctor.
Witherspoon said some parents have told her they had to pay a fee when they returned later to get the form filled out — another reason to get it done during the regular well-child visit when possible.
Geer acknowledged that the process can be complicated, especially for new parents.
“You have to know that you need these things,” she said, “so there has to be a clear message from the school systems statewide to potential families that may have never navigated this system before.”
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