• All student health services are confidential. Parents, professors and peers will not be given information without your written authorization
  • Submitting our Authorization to Release Form is necessary if you'd like your medical records to be released to you or someone else.
  • A signed, submitted release form is required each and every time a request is made.
    • Print it out
    • Please fill it out completely
    • Sign the signature line

You may complete the form in our office, fax to 314-516-5988, or mail it to:                                 

    • One University Blvd 131 MSC, St. Louis, MO 63121