Student Patients/Clients can access much of their medical record via the Student Health Portal. The following forms authorize Habif Health and Wellness Center to use and disclose protected health information in accordance with the patients authorization. All requests are processed by our Health Information Release Services. Please download the appropriate form and submit to the appropriate department.
- Consent for verbal communication of Protected Health Information (PDF)
- Request for Information to be released to an individual patient and/or their guardian/personal representative (PDF)
- Request for information to be released to a doctor, lawyer, or other 3rd party (PDF)
- Release for Medical Services for Minors, Parental Consent-does not include Mental Health services (PDF