Records Release Form

If you are a current or former student who still has access to the student health services portal, you can login in to the portal to access your Medical Release Form:

If you no longer have access to the Student Health Services Portal, you can complete the medical release form. A printable copy for download:

Please email to 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.