Forms
The following files are in PDF format. A free PDF reader, Adobe Acrobat, is available for download.
- Application for the Learning Disabilities Program
- Health Report
- Meningitis Waiver
- Petition to enroll in Student Health Plan
- Release of Medical Records form
- UHCS access request
- Request for Medical Leave of Absence
- Request for Re-entry from Medical Leave of Absence
Release of Medical Information
Since all your medical records are strictly confidential, you must provide us with a written request specifying information desired and where you wish it to be sent. This form may be downloaded at Release of medical information (PDF). Fax to: 617-373-2601.
This request of information (ROI) must include:
- your name and address
- telephone number and e-mail address
- school ID number
- dates attended (including when you left and whether or not you graduated)
- your signature
When you have graduated, send us a ROI and we'll send your records to the office of your new primary care practitioner.
Please allow at least two (2) weeks to process the request. If there is an urgent need for medical records for clinical care, please call us at (617) 373-3275 to let us know the request must be expedited.