Santa Clara University

Confidentiality

Medical records are confidential by law and are not released to anyone -- including parents, spouse, friends, and/or University personnel -- without the written consent of the patient.

Medical Release Form

A medical release form is required before any medical records can be sent or received. Select the appropriate form:

>>> Request form to release Student Health Center records to another facility
>>> Request form for the Student Health Center to obtain records from another facility

Instructions

Follow these steps to complete the above forms:

• 1. Complete the medical release form.
• 2. Include contact phone number in case there are any questions.
• 3. Sign the form.
• 4. Fax form to 408-554-2376.

Note: We will be unable to process your request without a signature.