Student Health Services
Current and former students may request specific information from their Student Health Center medical record by submitting a Release of Authorized Information Form (PDF) to the Student Health Center. Please review our Confidentiality policy prior to submitting this form.
This form may be submitted:
- in person
- by fax to 215-951-6867
- by mail: Student Health Center, 4201 Henry Avenue, Philadelphia, PA 19144