Release of Medical Information

For those who wish to have a copy of their medical records or to have a copy forwarded to a health care provider or a health-care facility, please submit request to:

Medical Records - Correspondence
UCONN Student Health Services
U-2011, 234 Glenbrook Rd
Storrs, CT 06269

Fax#: 860.486.5300
Phone#: 860.486.0750

If you are requesting your records from Counseling and Mental Health Services please submit your request to:

UCONN Counseling and Mental Health Services
U-2011, 234 Glenbrook Rd
Storrs, CT 06269

Fax#: 860.486.9159
Phone#: 860.486.4705

Your request will be processed within 2 weeks of receipt. Please be sure to include your telephone number in the event we need to contact you.

FEES

There is no charge for medical record copies while you are a current student at the University of Connecticut or if they are sent to another Health care provider for continued care.

Once you have left the University; the State regulated charge is 0.65 per page.

REQUEST SHOULD INCLUDE

Full legal name and Social Security Number or Student Identification Number and date of birth. (Include your name while enrolled at University of Connecticut if different)

What part of record you want (be specific: per date(s); type of problem) and the purpose for the release. If you want the entire record please write, I want my entire health record while at the University of Connecticut.

List the complete address for where to send records and telephone number. If records are to be faxed, please include the fax number. Please note, entire records cannot be faxed due to the volume and the concern for your privacy.

Include your phone number and a billing address.

Sign (written signature) and date to validate.

Click HERE for the Authorization for Release of Health Information form.