Medical Records & Forms

Medical Record Form

All incoming students are required to submit a medical record to Bucknell Student Health prior to arrival on campus.

Due Dates: Medical forms should be submitted no later than:

  • June 15 for fall enrollment.
  • January 3 for spring enrollment.
  • May 28 for summer enrollment.

Do not send incomplete medical records if deadline cannot be met. Please notify Bucknell Student Health if the Medical Record Form will not be completed and mailed within one month of the deadline.

Do not attach immunization records to the medical record; the dates must be recorded on the medical form.

Release of Medical Records

Bucknell Student Health is required by government regulations to receive written permission from a student before sharing any medical information with other health providers (for reasons other than continuation of care). This written permission is also needed for any disclosure of information to a student’s parent/guardian. 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 sent 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. Authorization forms for release of information may be obtained below or at the Student Health office.

Current Students and Post-2012 Graduates

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


Bucknell Student Health


Graham Building, enter from 7th Street


Monday – Friday: 8:30 a.m. – 4:30 p.m., Except Thursday
Thursday: 10:00 a.m. – 4:30 p.m.
Saturday - Sunday: 10:30 a.m. – 2:00 p.m., During regular semester