Medical Record Release Forms
All medical information is confidential and will not be released without written, informed consent. To obtain your medical information from Student Health Services, or to allow for your medical information to be sent to Student Health Services, please print, complete, sign and send the applicable form. Please include the ‘Cover Sheet’ with either release form to provide the necessary information. Requests for medical records require a minimum 7-10 business days to process. SHS will not send information to a non-encrypted email account. For students who have visited SHS, they are able to create a MYCHART account and view many of their own records.
- Authorization Cover Sheet (PDF) - Fax cover sheet to include if you are faxing in your request.
- Form to Request Copy of Medical Records (PDF) - This form is to be filled out if you need to request records from Student Health Services to be released to you or to another person/place that you specify. This is not to be used by parents or guardians to view their student's health records. Please refer to the Privacy Notice Packet.
- Authorization to Release Patient-Related Information TO Wheaton College (PDF) - This form is for requesting an outside provider/clinic to release medical records to Wheaton College Student Health Services.
- Privacy Practices Packet -This is form is specific for while students are at Wheaton College, regarding privacy laws, billing practices and permission to speak with listed individuals.
Forms Related to Entrance Requirements
- Entrance medical form for Summer Graduate History Form
- Entrance medical form for new and transfer undergraduate students
- Entrance medical form for undergraduate students returning after not being enrolled the previous semester
- Entrance medical form for new graduate students
- Policy Regarding Minors (PDF) -If a student is under the age of 18, this form must be filled out by a parent or legal guardian.