Student Wellness Services

Health Services


Medical Records Request

Please be advised that Medical Record Requests is temporarily suspended until further notice. Thank you.

Authorization to Obtain and/or Disclose Medical Information Form

Please print and submit the following form for all requests for medical records. 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.

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 by that time. Please request your record from your physician when possible as we may no longer have your record.

You can email the form to, 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
Willard-DiLoreto Complex, 1st Floor
1615 Stanley Street
New Britain, CT 06053