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)
Form-AsthmaHistory0903
(PDF, 20 KB)
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.
- Request Records from the Health Center be sent to another Medical Provider OR Patients can request a copy
Please complete this form if you need the Health Information Management Staff to send your records to another provider; OR to request records be sent to you or to someone other than a medical provider. - Request Records from Another Provider be sent to the Health Center.
Please complete this form(s) if you need the Health Information Management Staff to request your records from another provider in order to continue care at the Student Health Center.
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
