Request for Release of Medical Information

In order for Bucknell Student Health to release your medical information, you must provide a written request.

Please be aware that any information release that is not directly to another physician/medical facility for continuation of care CANNOT be faxed or emailed - it must be sent through regular mail or picked up by the patient.

Current Students and Recent Alumni

Current students and alumni who graduated after Spring 2012 should use the following form to request copies or release of medical information:

› Geisinger Medical Center Authorization to Release Medical Information

Alumni (class of 2012 and prior)

Alumni who graduated in Spring 2012 and prior should use the following form to request copies or release of your medical information.

› Alumni Disclosure of Protected Health Information