Request for Medical Records
Because an actual signature is required to release medical records and information, staff at the ACU Medical Clinic are not allowed to process requests or authorizations received via email. Requests must be made by the student.
Please download the Authorization to Release Information form, complete all required fields, sign it and mail or fax the form to the clinic. Each request will be handled within 10 business days.
A fee may be charged for copying, mailing, shipping or otherwise delivering health care information.
Local, state or federal agencies requesting health care information may be intitled by statute to a different fee. The agency should inform the clinic of this fact at the time of the request.