Immunization Forms

All current immunization forms and forms for Student Health can be found at

This includes the Immunization Record Form and the Release of Health Records FROM Mason Form.


Immunization records due by First Day of Fall Classes.

All newly admitted or newly re-admitted summer/fall 2018 students must submit immunization records by the deadline. SHS recommends newly admitted students wait until May to begin submitting records due to upcoming form changes.

Past Due Immunization Records

If you have a hold and late fee, you must complete the immunizations and pay the late fee to Student Health Services to have your hold removed. The hold will be released usually by the end of that business day, if after 4:30 pm it will be processed the next business day.


Note: Do not include social security numbers on your immunization records.

Immunization Office

Hours: Monday - Thursday: 8:30- 4:30 pm, Friday: 12:30 - 4:30 pm

Phone: 703-993-2135

Email: *questions only, do not submit records via email*

Address: Student Union Building I (SUB I), Rooms 2347 & 2348

4400 University Drive, MS 2D3, Fairfax VA 22030

Patient Portal

Immunization Forms

Immunization Fees