Health Care Forms

Who do you want to recieve a copy of your medical records?

  1. Complete the Request or Send Records form.
  2. Fax, mail, or deliver the form to the Student Health Center.
  3. The Student Health Center will process and act upon your request within 30 days.
  1. Complete the Authorization for Use and Disclosure of PHI form.
  2. Fax, mail, or deliver the form to the Student Health Center.
  3. If the form is filled out correctly, the records your designated will be provided to the person you authorized.

Do you need to waive the student health plan requirement?

  1. Complete the Waiver form
  2. Fax, mail, or deliver the form to the Student Health Center.
  3. The Student Health Center will process your request to waive the student health plan requirement upon receipt of the form.