Records Release Form

Students and Alumni:

If you are a current or former student and you still have access to your student health services portal, please log in here: 

*Once logged in, click ‘Forms’ and then click on the Medical Release Form.  Fill out the requested information and then submit.

If you no longer have access to your student health portal you can access a paper copy of the form here:

Please email to or fax 843-953-6377. Someone will be in contact with you 24-48 hours of your received request.  Please allow 5-7 business days for processing your request.

Disclosures for treatment, payment and health operations may include the following:

Treatment: Information obtained by a nurse, nurse practitioner, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. We will also provide pertinent health information in your medical record to any health care consultants you are referred to for more specialized care.