Forms

Immunization Forms

Summer/Fall 2024 form for new students

Mason Immunization Record Form 2024 (pdf)

Certificate Of Medical Exemption for Immunizations Requirements 2024 (pdf)

Spring 2025 form for new students

Spring 2025 Certificate of Immunization George Mason Form (pdf)

Clinical Forms

ADD/ADHD Medication Contract (pdf)

ADD/ADHD Diagnosis and Treatment Documentation Form (pdf)

Allergy Clinic Student Employee Agreement Form (pdf)

Cardiovascular screening for medication form (pdf)

Injectable medication order authorization form (pdf)

Medical Records Request Forms

Release of Health Records FROM Mason (pdf)

Request for release of medical records TO Mason (pdf)

Health Promotion Forms

Safer Sex Condom Request Form

Program Request Form

Feedback and Appeal Forms

Online feedback form

No show fee appeal form

SHS transcription fee appeal form