Written authorization is required to release medical information from Student Health Services to a designated entity.

If you would like Student Health Services to release your medical information, please complete and sign this form (PDF) and send it to [click-for-email] or fax to 215-204-4660. THIS IS NOT FOR TEMPLE UNIVERSITY HOSPITAL OR HEALTH SYSTEM, THIS IS ONLY FOR TEMPLE UNIVERSITY STUDENT HEALTH.  (For Temple Hospital or Health System call 215-707-3755).

Written authorization is also required to have medical information released to Student Health Services.

If you need medical records for your visit at Student Health Services, please complete and sign this form (PDF) and send to your doctor’s office.