Requests for Medical Information

Emergency Contacts

Counseling and Psychological Services (CAPS) records are kept for seven years as required by Virginia law. In order to provide any information about a student seen at CAPS, the student must complete our Release of Information form.

Students can complete this form in our office during business hours. We need to see a current photo ID. If there has been a change in the student’s name since being seen here, we will need to see an ID with the former name on it as well as one with the current name.

If unable to come directly to our office, follow the link below to download a copy of the release. Any signature being submitted to us via fax must have been witnessed by notary public. When faxing it back to us, it should be also accompanied by a clear and legible copy of a photo ID (ID’s for both current and previous last names, if applicable). Please provide a good contact phone number for yourself on the release of information. After faxing the form, the original must be mailed to us at:

George Mason University
Counseling and Psychological Services
4400 University Drive, MS 2A2
Fairfax, VA 22030

When we receive the faxed release, you can expect a phone call from one of our staff within seven (7) business days to further verify what is needed.

If you have any questions about this process, please call us at 703-993-2380.

Release of Information Authorization Form