BOCA RATON STUDENT HEALTH SERVICES

Authorization for Release of Medical Information - from FAU

Directions:

Print a blank form and then complete the form by hand.

Deliver the form to Student Health Services via one of the following methods:

• Fax a signed copy to (561) 297-0494
• Mail a signed copy to:
  
  Florida Atlantic University
  Student Health Services
  777 Glades Road
  Boca Raton, FL 33431

• Bring in a signed copy to the Student Health Services office on the Boca Raton campus.

Authorization for Release of Medical Information - to FAU

To have your medical records sent to FAU, print and complete the blank form and provide it to the provider in possession of your records. Please allow sufficient time prior to your appointment for Student Health to receive your records.