Skip to main content
×
University Links
  • Academic Life
    • Class Registration
    • Registration Info
    • Student Advising
    • Student Success
    • Military Outreach
    • GPA Calculator
    • University Catalog
  • ​
    • Academic Calendars
    • Scholarships
    • Financial Aid
    • Tuition & Payments
    • FAFSA
    • Bookstore
  • Student Engagement
    • Dean of Students
    • Housing
    • Parking
    • Dining
    • Health
    • Career Services
    • Recreation
    • Panther Involvement Network (PIN)
  • ​
    • Campus Life
    • Health Insurance
    • Student Handbook
    • Code of Conduct
    • Get Emergency Alerts
    • Technology
  • Resources
    • Library
    • Calendar
    • Contact Us
    • Album 88
  • Tools
    • Email
    • PAWS
    • GoSOLAR
    • iCollege
  • Coronavirus Update
  • Student A-Z Index
  • Help Center
  • Safety & Security
×
University Links
  • Finance & Admin
    • Toolkit
    • Forms
    • Training
    • University Senate
    • University Policies
    • Budget & Planning
    • Disbursement & Accts. Payable
    • Purchasing & Business
    • Spectrum Services
    • Risk Management
    • Ombudsperson
  • Human Resources
    • Open Enrollment
    • Payroll & W2 Information
    • Benefits
    • Vacation & Leave
    • Work/Life Programs
    • New Hires
    • OneUSG Training
    • Employee Resources
    • Managers
    • Retirees
    • Faculty Handbook
    • Staff Handbook
  • Services & Support
    • Facilities Management
    • URSA
    • Mail Services
    • Printing
    • PantherDining
    • Catering
    • Travel Reservations
    • PR & Marketing Communications
    • Legal Services
    • Institutional Effectiveness
    • Emeriti Association
  • Tools
    • Email
    • Send A File
    • PAWS
    • GoSOLAR
    • iCollege
    • Digital Measures
  • ​
    • OneUSG Connect
    • Panthermart
    • Spectrum
    • CETLOE
    • Stacks
    • Training and Learning
  • Resources
    • Library
    • Calendar
    • Facilities
    • Contact Us
    • Album 88
  • Coronavirus Update
  • Staff A-Z Index
  • Help Center
  • Safety & Security
  • Georgia State Home
  • Student Affairs
    • About
      • A Message from the Vice President
      • News
        • 2018 News Archives
        • 2017 News Archives
        • 2016 News Archives
        • 2015 News Archives
        • 2014 News Archives
      • Contact Us
    • Learn
      • Black Student Achievement
      • Civic Engagement
      • Leadership Programs
      • Multicultural Center
    • Play
      • Spotlight Programs Board
      • Panther Activities Council
      • Greek Life
      • Leadership Development
      • Recreational Services
      • Student Media
      • Student Organizations
    • Health
      • Counseling & Testing
      • Disability Services
      • Student Health Clinic
      • Student Health Promotion
      • Recreational Services
    • Rights
      • Code of Conduct
      • Student Government Association
      • Student Judicial Board
      • Emergency Assistance
      • Emergency Withdrawal
      • Victim Assistance
      • FERPA
    • Parents
      • Parent Relations
    • Activity Fees
      • Committee Members: Atlanta
      • Committee Minutes: Atlanta
      • Allocation Processes: Atlanta
      • Mandatory Student Fees: Atlanta
      • Student Activity Fee: Perimeter
      • Mandatory Student Fees: Perimeter
    • SPRING 2021
  •   
    • Print/Email

  • Search Options
  • Faculty & Staff
  • Students
  • Map
  • Student Affairs
  • About
    • A Message from the Vice President
    • News
      • 2018 News Archives
      • 2017 News Archives
      • 2016 News Archives
      • 2015 News Archives
      • 2014 News Archives
    • Contact Us
  • Learn
    • Black Student Achievement
    • Civic Engagement
    • Leadership Programs
    • Multicultural Center
  • Play
    • Spotlight Programs Board
    • Panther Activities Council
    • Greek Life
    • Leadership Development
    • Recreational Services
    • Student Media
    • Student Organizations
  • Health
    • Counseling & Testing
    • Disability Services
    • Student Health Clinic
    • Student Health Promotion
    • Recreational Services
  • Rights
    • Code of Conduct
    • Student Government Association
    • Student Judicial Board
    • Emergency Assistance
    • Emergency Withdrawal
    • Victim Assistance
    • FERPA
  • Parents
    • Parent Relations
  • Activity Fees
    • Committee Members: Atlanta
    • Committee Minutes: Atlanta
    • Allocation Processes: Atlanta
    • Mandatory Student Fees: Atlanta
    • Student Activity Fee: Perimeter
    • Mandatory Student Fees: Perimeter
  • SPRING 2021
  • Menu
  • About
    • News
      • 2018 News Archives
      • 2017 News Archives
      • 2016 News Archives
    • Clinic Information
    • Fees, Payment & Insurance
    • Forms
    • Patient Rights & Responsibilities
    • Contact
  • Services
    • Urgent Care
    • Primary Care
    • Dispensed Medicine
    • Immunizations & Travel
      • Immunization Information
      • Immunizations Provided
    • Nutrition Services
    • Laboratory Tests
  • Women
    • Contraceptive Management
    • Pregnancy
    • Sexually Transmitted Infections
  • Men
  • Emergencies
  • Sexual Misconduct
    • After a Sexual Assault
    • Medical Support
    • Healing from Rape
    • Recognizing Abusive Relationships
    • Relationship Abuse Support
    • Preventing Sexual Violence
    • Help a Friend
    • Victim of Stalking
    • Obtaining a Protective Order
    • Effective Consent
    • Confidential Disclosure
    • Reporting Sexual Misconduct
    • Title IX
    • Sexual Misconduct Policy
    • Sexual Misconduct Board
    • Responsible Employee Defined
    • Accused of Sexual Misconduct
    • Request Training
  • Perimeter College
    • Rights & Responsibilities
    • Fees
    • Student Health Clinics Forms
    • Immunizations
      • Submit Immunization Documents
      • Required Immunizations
      • Waivers & Exemptions
      • Recommended Immunizations
      • Frequently Asked Questions
      • Copy of Immunization Records
  • SPRING 2021
  • Email
  • GoSOLAR
  • iCollege
  • PAWS
  • 88
Student Health Services
  • About
    • News
      • 2018 News Archives
      • 2017 News Archives
      • 2016 News Archives
    • Clinic Information
    • Fees, Payment & Insurance
    • Forms
    • Patient Rights & Responsibilities
    • Contact
  • Services
    • Urgent Care
    • Primary Care
    • Dispensed Medicine
    • Immunizations & Travel
      • Immunization Information
      • Immunizations Provided
    • Nutrition Services
    • Laboratory Tests
  • Women
    • Contraceptive Management
    • Pregnancy
    • Sexually Transmitted Infections
  • Men
  • Emergencies
  • Sexual Misconduct
    • After a Sexual Assault
    • Medical Support
    • Healing from Rape
    • Recognizing Abusive Relationships
    • Relationship Abuse Support
    • Preventing Sexual Violence
    • Help a Friend
    • Victim of Stalking
    • Obtaining a Protective Order
    • Effective Consent
    • Confidential Disclosure
    • Reporting Sexual Misconduct
    • Title IX
    • Sexual Misconduct Policy
    • Sexual Misconduct Board
    • Responsible Employee Defined
    • Accused of Sexual Misconduct
    • Request Training
  • Perimeter College
    • Rights & Responsibilities
    • Fees
    • Student Health Clinics Forms
    • Immunizations
      • Submit Immunization Documents
      • Required Immunizations
      • Waivers & Exemptions
      • Recommended Immunizations
      • Frequently Asked Questions
      • Copy of Immunization Records
  • SPRING 2021
  • About
    • News
      • 2018 News Archives
      • 2017 News Archives
      • 2016 News Archives
    • Clinic Information
    • Fees, Payment & Insurance
    • Forms
    • Patient Rights & Responsibilities
    • Contact
  • Services
    • Urgent Care
    • Primary Care
    • Dispensed Medicine
    • Immunizations & Travel
      • Immunization Information
      • Immunizations Provided
    • Nutrition Services
    • Laboratory Tests
  • Women
    • Contraceptive Management
    • Pregnancy
    • Sexually Transmitted Infections
  • Men
  • Emergencies
  • Sexual Misconduct
    • After a Sexual Assault
    • Medical Support
    • Healing from Rape
    • Recognizing Abusive Relationships
    • Relationship Abuse Support
    • Preventing Sexual Violence
    • Help a Friend
    • Victim of Stalking
    • Obtaining a Protective Order
    • Effective Consent
    • Confidential Disclosure
    • Reporting Sexual Misconduct
    • Title IX
    • Sexual Misconduct Policy
    • Sexual Misconduct Board
    • Responsible Employee Defined
    • Accused of Sexual Misconduct
    • Request Training
  • Perimeter College
    • Rights & Responsibilities
    • Fees
    • Student Health Clinics Forms
    • Immunizations
      • Submit Immunization Documents
      • Required Immunizations
      • Waivers & Exemptions
      • Recommended Immunizations
      • Frequently Asked Questions
      • Copy of Immunization Records
  • SPRING 2021

Forms

The following forms and documents are needed by students who will be utilizing the Student Health Clinic’s services:

  • Release of Information Consent Form
  • Consent to Treat Minor Form
  • Immunization Form
  • New Patient Information
  • Study Abroad Form
  • Privacy policy Oct 2020

  • About
    • Contact Georgia State
    • Employment
    • University Policies
    • Office of the President
    • Campus Maps
    • Administration
    • News & Events
  • Student Success
    • Admissions
    • Degrees & Majors
    • Graduate Programs
    • College to Career
    • University Library
    • Law Library
    • Bookstore
  • Connections
    • Magazine
    • Alumni
    • Giving
  • Arts & Ideas
    • Rialto Center
    • Album 88
    • Research
    • URSA
  • Athletics
    • Tickets
    • Sports
    • Panther Athletic Club
    • Recruits
    • News
  • Campus Life
    • Events
    • Student Affairs
    • Housing
    • Parking
    • Dining
    • Recreation
    • Safety
Georgia State University
Georgia State University33 Gilmer Street SE Atlanta, GA404-413-2000
Contact Georgia StateView legal statementPrivacy NoticesState AuthorizationWebsite Feedback©2020 Georgia State University
Print/Email