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Measles and Mumps Requirement Form
Domestic students, you will need to complete the form and submit it to the Center for Student Health
and Counseling for processing.
International Student Measles and Mumps
Requirement Form
If you are an international student, please complete this form and submit it to the Center
for Student Health and Counseling for processing.
Authorization of Release
Please complete this form if you need to authorize your medical and/or mental health
records to be released or discussed with an outside provider. Records are released
free of charge from provider to provider for continued care. If records are
requested to be released to the individual there will be a fee based on the
complexity of preparation. This fee will be billed to the student's account.
Claim Forms: Please note that claim forms are not required. To submit a claim, make a copy of
the bill/receipt, write your name, medical ID number, PSU ID number, and what university
you attend directly on the bill/receipt. Submit to:
Aetna Student Health
P.O. Box 15708
Boston, MA 02215-0014
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