Authorization to Release/Obtain Medical Records
Medical and immunization records submitted to or generated by Student Health Services are held on file for 10 years. Your records may be released/obtained by completing the release form below. Please note: the form cannot be used for the re-release of confidential information provided to Student Health Services by other individuals or agencies. Such requests should be referred to the original individual or agency. Records pertaining to HIV tests or alcohol/drug treatment require separate authorizations.
Download and print the release form below; complete the form and fax or mail it to us. Please be aware that it may take up to two-weeks for us to process your request for release of information, depending on the current volume of requests.
Authorization to Release/Obtain Medical Records form: PDF (38KB) | Word (60KB)