Authorization for Release of Medical Information from FAU
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 a signed copy to the Student Health Services office.

Authorization for Release of Information to FAU
To have your medical records sent to FAU, print and complete the 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.

• Dental Clinic
• Student Health Services
• Pharmacy

Prior to receiving an immunization from Florida Atlantic University's Student Health Clinic, you should read the appropriate What You Need To Know Vaccination Information Sheet before signing the consent form in the Clinic.

If you are under the age of 18, your parent or legal guardian must also sign the consent form. Additionally, if you have never been seen before in our clinic, you will also need to fill out the Medical History Form and sign the Release to Treat section on the second page.

See our Frequently Asked Immunization Questions for more information about Immunization requirements.
Immunization Form
Immunization FAQs

Note: If you have never been seen before in our clinic, you will need to print and fill out the Medical History Form and sign the Release to Treat section on the second page. Bring the completed form to your appointment.
Medical Health History Form