Forms

Immunization Forms

George Mason Certificate of Immunization (formerly Immunization Record Form) (pdf)

George Mason Certificate of Religious Exemption (pdf)

George Mason Medical Exemption 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

Immunization late fee appeal form

Online feedback form

No show fee appeal form

SHS transcription fee appeal form