Medical Dietary Accommodations

If you wish to make any special dietary requests for your child, please print the Special Dietary Accommodations document below.

Have your State Licensed Healthcare Professional complete the form.

You may send completed forms to the District office at

650 E. Center Street, Chino Valley, Az, 86323

Or Fax to (928) 636-1434.

You may request an appeal if your child was denied diet modification by contacting the School Nurse.

Physicians Request for Dietary Modification form must be on file with school nutritionist before diet modifications are available to your child.

If you have any questions, please contact

Lorie Smith at (928) 583-5409 or

Download the form here:

Medical Statement for Dietary Accommodations.pdf

This institution is an equal opportunity provider