How to Complete Georgia Form 4400: Certificate of Scoliosis Screening

Georgia Form 4400, the Certificate of Scoliosis Screening, is the one-page document Georgia public schools use to confirm that a student entering sixth or eighth grade has either been screened for spinal curvature or has been opted out of screening by a parent or guardian. You must return the completed form to your child’s school no later than 90 days after the student begins that grade.¹

When the Form Is Due and Who Needs It

The requirement applies at two grade entry points: sixth grade and eighth grade. A screening done earlier counts, so long as it falls within the allowed window. For the sixth-grade requirement, a screening performed as early as the first day of fifth grade is accepted. For the eighth-grade requirement, a screening performed as early as the first day of seventh grade is accepted.¹ Whatever the screening date, the form itself has to be in the school’s hands within 90 days of the student starting the sixth or eighth grade year.

Where to Get the Form

The current PDF is on the Georgia Department of Public Health website and includes both English and Spanish versions.¹ Many schools hand out blank copies at registration or send them home with the written screening notice. If your child will be screened on campus, the school nurse often fills out and files the form for you; you only need to touch it if you plan to opt out or if you’re using a private provider.

Filling Out the Form

The form has three parts: student information at the top, screening results in the middle, and a parent opt-out block at the bottom. You use the student information section every time, and then either the results section or the opt-out block — never both.

Student Information

Enter the student’s full legal name (first, middle, last), date of birth, gender, current grade, home address, and school name. Add the parent or guardian’s name, phone number, and email. Match the school’s enrollment records exactly so the form files cleanly against your child’s record.

Screening Results

The person who performs the Adams Forward Bend Test fills in this part. There are three result options:

Negative screen — no signs of spinal abnormality observed.
Needs further evaluation — the screener saw something that warrants a closer look.
Referred to provider — the student has already been referred for follow-up.

A comments field lets the screener note specific observations. Below the results, the screener prints their name and office address, signs, and dates the form, and indicates whether the screening was done by a physician practice, county health department, or licensed school nurse.¹ A license number isn’t requested — name, address, and signature are enough.

Who Can Perform the Screening

You don’t need to see a doctor. Georgia accepts screenings performed by a physician with an active Georgia license, a physician assistant, a nurse practitioner, a registered nurse, a licensed practical nurse, or other staff working under a physician’s supervision. Nurses at a county health department and licensed school nurses also qualify.¹ If you take your child to a private provider, any of these professionals can conduct the exam and sign the form.

The screening itself is quick and painless. The student stands with feet together and knees straight, then bends forward at the waist with arms hanging toward the floor.² The screener looks for uneven shoulders, a rib hump on one side, or a waistline that shifts off center. Visible asymmetry doesn’t mean the child has scoliosis; it means the “needs further evaluation” box gets checked.

Opt-Out Block

Parents can decline the school-based screening. The statute exempts a child whose parent or guardian objects.³ Schools send a written notice at least two weeks before a scheduled screening, and parents who want to opt out are expected to submit a written objection within five days of receiving that notice.⁴

To opt out on Form 4400, skip the screening results section and complete the parent/guardian block at the bottom, labeled “Parent/Guardian – Complete This Portion Only if Student Will Not Be Screened.”¹ Return the form anyway so the school can document the refusal; the district keeps a list of opted-out students and shares it with the health authority.⁴

Turning the Form In

Return the completed Form 4400 to your child’s school no later than 90 days after the student begins sixth or eighth grade.¹ Earlier is fine — you can submit as soon as the screening is done, even if that was during the prior school year. When the school handles the screening on campus, the nurse typically files the form directly. When a private provider does the screening, drop the signed form at the front office or registrar, or mail it in.

Check every required field before you turn it in. Missing information can send the form back to you, and an unsubmitted form past the 90-day mark can prompt follow-up from school administrators.

What a Referral on the Form Means

If the screener checks “needs further evaluation,” the local health authority — not the school — is responsible for notifying the parent or guardian and recommending further professional attention.⁴ The form’s own instructions tell parents to take the student to a medical provider for a more detailed evaluation, and note that your physician or local health department can help find one.⁵ A flagged screening is a prompt to follow up, not a diagnosis.

1
Georgia Department of Public Health. Form 4400 – Scoliosis Screening
2
MedlinePlus. Forward Bend Test
3
Justia. Georgia Code 20-2-772 – Rules and Regulations for Screening of Students for Scoliosis
4
Georgia Secretary of State. Subject 511-5-8 Screening of Public School Children for Scoliosis
5
Georgia Department of Public Health. Certificate of Scoliosis Screening Form 4400