(703) 993-2831 Clinic & After-Hours Nurse Advice
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Forms

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Immunization Forms

Mason Immunization Record Form

Certificate Of Medical Exemption for Immunizations Requirements

Medical Records Request Forms

Release of Health Records FROM Mason

Request for Release of Medical Records TO Mason

ADD/ADHD Forms

ADD/ADHD Diagnosis and Treatment Documentation Form

ADD/ADHD Cardiovascular Screening Form

ADD/ADHD Medication Contract

Allergy and Travel Clinic Forms

Allergy Clinic Student Employee Agreement Form

Travel Clinic Assessment Form

Feedback and Appeal Forms

Online feedback form

No show fee appeal form

SHS transcription fee appeal form

Patient portal error report form

Safer Sex Condom Request Form

Safer Sex Condom Request Form

CLINIC LOCATIONS
By appointment, call 703-993-2831.
Fairfax Clinic • SUB 1, Room 2300
Mason Square Clinic • Van Metre Hall, Room B102

Immunization Office • 703-993-2135
Insurance Office • 703-993-2826

An office of University Life
© Copyright 2018 George Mason University
For All Inquiries: 4400 University Drive, Fairfax, Virginia 22030 | TTY: Skype Chat | Phone: 703-993-1000

SHS is accredited by AAAHC
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