Release of Medical Record

Student medical records are strictly confidential. Those student’s looking to have a medical record or clinical information shared, must provide UHCS with a written request specifying the information desired and where you wish this information to be shared. The attached form must be mailed or faxed to:

University Health and Counseling Services
Northeastern University
Forsyth Building, Suite 135
360 Huntington Avenue
Boston, MA 02115-5000

Fax: 617-373-2601

Release of Medical Record