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Forms

Click on the links to open the forms. Forms are in Adobe Acrobat format. Click here for the latest version of Acrobat.

Clinical Forms: Please print out and complete only if directed to by a nurse or through the online appointment system.

Administrative Forms

Authorization to Release Medical Information Form(s)  - Individuals who would like to request copies of medical records from the Health Center, OR have staff request medical records be sent to the Health Center, must complete the appropriate form.  All requests should include a copy of a photo ID (ie. Driver’s license or Student ID).

Please note electronic signatures are not accepted.

QuickPay Credit Card Authorization Form - This form allows you to have a credit card number on file for use at the Health Center and Pharmacy. Please print and fax to 512-245-1677 or mail to Texas State University, Student Health Center, Attn: Amber Trojcak, 601 University Drive, San Marcos, Texas 78666. Please indicate the limit of the authorization in the upper, left corner of the form. The Authorization For Credit Card Use must be signed by the cardholder. All forms received are kept in a secured area within the Cashier Department at the Student Health Center. If you have any questions, please call the Student Health Center Cashier Department at 512-245-2161, option 4.
 

Patients should bring their insurance card to every visit.
 
Parental Consent to Treatment for Minor - Please complete and sign all sections. Return to the SHC by faxing to 512.245.9288, Attn: Medical Records or mail to the Texas State Student Health Center, Attn. Medical Records, 601 University Dr. San Marcos, TX 78666.

Vaccine Information Statements