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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.
ADHD_flyer (PDF, 837 KB)
Allergy Flyer (PDF, 1 MB)

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.

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