Records Release Form
If you are a current or former student who still has access to the student health services portal, you can access the Medical Release Form through your student health portal.
- Login to your student health portal.
- Select "Forms"
- Select "Medical Release Form"
- Complete the requested information and submit.
If you no longer have access to your Student Health Services Portal, you can print and complete the medical release form listed below:
Please email your completed form to healthservices@charleston.edu or fax 843.953.6377. Someone will be in contact with you 24 - 48 hours after we receive your request. Please allow 5 - 7 business days to process your request.
Disclosures for treatment, payment and health operations may include the following:
Treatment: Information obtained by a nurse, nurse practitioner, physician or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. We will also provide pertinent health information in your medical record to any health care consultants you are referred to for more specialized care.