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Primary and Specialty Medical Care Forms

It is recommended 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

*Required for all patients receiving the COVID-19 vaccination

Vaccine Specific Information

Please print or save the specific version for the vaccine you are scheduled to receive.

Vaccine Record

  • If you are looking for a record of a COVID-19 vaccination administered through University Health Services, a record of your vaccination is available by accessing the Appointment Portal and selecting the Immunization tab.

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

Form available here: Medical Records Release Form

Students are advised to call the Pharmacy at 979.458.8292 to verify that University Health Services stocks the medication. Once it has been confirmed that the medication is available, the student must complete the Prescription Transfer Form. 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

Students who will be receiving an ultrasound are advised to review the below form, including the necessary preparations for specific ultrasound exams.

Form available here: Ultrasound Exams Overview

Tuberculosis (TB) screening is required for incoming international students (non-permanent residents) that were born in, hold citizenship or have resided in one of the following countries or territories for more than three (3) months. View the American College Health Association guidelines for a list of these specific countries. Students are welcome to use this form and attach a copy of their blood test results or students may have a T-Spot blood test performed once they arrive in College Station. Per Texas A&M requirements, the Tuberculosis Blood Testing results are only accepted if completed within 12 months prior to the start of the semester the student is choosing to enroll.

Return the completed Tuberculosis Screening form by email to

Form available here: Tuberculosis Screening

Counseling and Mental Health Care Forms

University Health Services Counseling and Mental Health Care is able to provide relevant documentation and/or copies of your records to you or others in a manner consistent with state laws governing the release of confidential information. Prior to completing the release of information form, review the request for documentation information

Current students: fill out the release of information request form.

Former students: fill out the release of information request form.

Contact us if you have any questions about this process.

University Health Services recognizes that some students may need assistance in locating and connecting with mental health support in the community. If you believe you are in need of this type of support, you can either schedule an appointment to meet with a University Health Services Case Management Referral Coordinator (CMRC) or you can request a list of resources be sent to you through the appointment portal without needing to come in for an appointment. Receiving a list will allow you to explore and reach out to community options on your own. To request a list, complete the referral questionnaire.