Student Forms

If a new/transfer student will be under the age of 18 on the first day of university classes, the following form is required in order to provide legal consent for any possible medical care should it be necessary.

Form available here: Consent for Medical Treatment of a Minor

This form is used by Patient Services and Case Management to release information regarding your medical care. Types of releases include: to another physician, to the patient, or another party as indicated by the student. These forms are episodic in nature and a new form must completed for each request. There may be a charge associated with this service.

For General Medical Records – Form available here: Medical Records Release Form

For Case Management Records – Form available here: Medical Records Case Management Release Form

This form can be given to the student’s physician to be filled out and returned to the SHS Preventive Medicine Department.

Form available here: Allergen Immunotherapy

Students are advised to call the Pharmacy at (979) 458-8292 to verify that SHS stocks his/her medication. Once it has been confirmed that the medication is available, the student must complete the Prescription Transfer Form to the best of his/her ability. The student may then either fax the form or bring the form to the Pharmacy located on the first floor of the Student Health Center. Please allow 48 hours for the processing of transfers.

Form available here: Prescription Transfer Form

This form is available for students to provide feedback and/or request an action regarding any charges, services rendered, or visits to the health center. SHS asks that the student be as specific as possible as to the events that occurred and any actions the student feels should take place. Once the form is submitted, it will be reviewed by Student Health Services. If there are any questions regarding this form, please contact Patient Services at (979) 458-8310.

Form available here: Student Feedback/Request Form

To submit an electronic version of this form, visit the following page: Student Online Feedback/Request Form

Tuberculosis (TB) Screening is required for all incoming international students that were born in, resided in, or traveled to one of the high risk countries listed on the ACHA/WHO list of high risk countries. Students are welcome to use this form and attach a copy of his/her blood test results or students may have a T-Spot blood test performed once he/she arrives in College Station. Lab results must be within 12 month of the entering semester.

Form available here: Tuberculosis Screening Form