These forms are specific for students seeking behavioral health services at SHS.
A Behavioral Health staff member will send you a secure message via the Patient Portal prior to your visit. Please reply to that secure message with the completed forms. Both completed forms must be returned prior to your visit.
Forms available here:
Records Release Forms
SHS Behavioral Health staff often work closely with Counseling and Psychological Services (CAPS) and Student Assistance Services (SAS). In some instances, the SHS staff member may request to share select records with these two entities to help them better serve our patients. SHS staff will secure message or instruct you during your visit if you are requested to complete these optional forms. If you receive this notification via secure message, please reply to that secure message with the completed forms.
Forms available here:
SHS recommends that you fill out the below form prior to your appointment in order to minimize your wait time. The form will also be available at the vaccination site if you are unable to fill it out in advance.
For All Vaccinations
- *SHS COVID Vaccine Consent Form (please complete and bring to your appointment)
- Vsafe Info Sheet (print or save for your reference)
*Required for all patients receiving the COVID vaccination
Vaccine Specific Information
Please print or save the specific version for the vaccine you are scheduled to receive.
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 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 be completed for each request. There may be a charge associated with this service. Completed forms can be submitted to email@example.com.
Form available here: Medical Records 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 in Outpatient Setting
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, complete the form on the following page: Contact Us
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 months of the entering semester.
Form available here: Tuberculosis Screening