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To request medical records for services provided at Student Wellness Services – Health please submit the form below.
Please print and submit the following form for all requests for medical records. Please be advised that medical records are only maintained by Connecticut state law for 7 years from the date of withdrawal or graduation from Central Connecticut State University. CCSU may not be in possession of your record.
Please expect normal processing time for all requests to take at least 30 days. All efforts will be made to process requests as quickly as possible. If we are unable to locate your record, we will notify you by that time.
Medical records will only be mailed to your home address. Please keep a copy for your record and use.
Authorization to Obtain and/or Disclose Medical Information Form
You can email the form to firstname.lastname@example.org, fax to (860) 832-2579, drop the form off in person to Student Wellness Services in Willard-DiLoreto Complex, 1st Floor, or mail to the following address:
Student Wellness Services - Health
Willard-DiLoreto Complex, 1st Floor
1615 Stanley Street