Release of Information Form

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Records Release.pdf

Use this form to authorize Student Health to release your medical records to another provider or to speak to your parent or other persons. Please print this form and complete it including your signature. You can bring it in to Student Health or Fax it to 419-289-5209. If you would like to email it, please call us first at 419-289-5200.www.ashland.edu/currentstudents/campusservices/healthservices