BOCA RATON STUDENT HEALTH SERVICES
Authorization for Release of Medical Information - from FAU
Directions:
Print a blank formand then complete the form by hand.
Deliver the form to Student Health Services via one of the following methods:
  • Fax a signed copy to (561) 297-0494
  • Mail a signed copy to:
    Florida Atlantic University
    Student Health Services
    777 Glades Road
    Boca Raton, FL 33431
  • Bring in a signed copy to the Student Health Services office on the Boca Raton campus.
Authorization for Release of Medical Information - to FAU
To have your medical records sent to FAU, print and complete the blank form and provide it to the provider in possession of your records. Please allow sufficient time prior to your appointment for Student Health to receive your records.
FAU Campuses: Boca Raton/Davie/Dania Beach/Fort Lauderdale/Jupiter/Treasure Coast Boca Raton Campus Danie Beach Campus Davie Campus Fort Lauderdale Campus Harbor Branch Campus Jupiter Campus Treasure Campus
 Last Modified 8/26/12