Student Health Services

Health History and Immunization Forms

The State of Oregon and Oregon State University require the submission of a completed health history form and proof of 2 doses of MMR (measles, mumps, rubella). The preferred method for submitting the information is via the Patient Portal. If you are unable to use the Patient Portal you may print the form from the following link and fax it to Student Health Services at FAX number 541-737-9665.

• Health History and Immunization Form
• International Student Health History and Immunization Form

Medical Record Release Form

A patient may receive a hard copy or his/her record at a cost per page or may have a copy forwarded without cost to his/her personal health care provider by completing the Authorization to Release Medical Information Form.

• Authorization to Release Medical Information Form

Both of the above forms require Adobe Acrobat Reader to view. If you haven't yet installed the program on your computer, you can download the application for free. Simply click on the icon below and follow the directions given.