Authorization to Release or Obtain Health Records Form

Allow your medical records to be released by Health Services, or allow another health care provider to release your records to Health Services. 

About Medical Records

Health and immunization records submitted to or generated by Health Services are held on file for 10 years.

Information About Students Over the Age of 18

Consent is required from students 18 years old and over, before Health Services can release any medical information to another person.

Only for Health Care Provided by Health Services

If other individuals or agencies have provided confidential information to Health Services, you cannot use the authorization form to re-release this information. For copies of medical records that came from another individual or agency, please contact that original individual or agency directly.

Processing Time

Please note that it may take up to two weeks to process your request for release of information, depending on the current volume of requests.

COVID-19: Submissions of Medical Records Release

We normally do not accept requests for medical records via email but we are doing so during the current COVID-19 pandemic. Please complete the consent form and submit via email.  If you are requesting immunization records only, we can release these via mail, fax or email.  However, we are not able to email your entire medical record, so please provide a fax number or mailing address to which we can send those records.

For the best experience use a non-mobile device.

To Submit this Form, or Get Help

Health Services

Student Life

University at Buffalo
Michael Hall, 3435 Main Street, South Campus
Buffalo, NY 14214

Phone: (716) 829-3316; Fax: (716) 829-2564