Medical Record Form

All incoming students are required to submit a medical record to Bucknell Student Health prior to arrival on campus. See a list of required forms in the the boxes below.

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. Find out how to authorize release of your medical records.

Required Medical Record Forms


ALL incoming first-year and transfer students must complete this form:

Your Medical Record Form *MUST* be received in Student Health prior to move-in day in order for you to receive your room key.

International Students

If you are an international student (undergraduate or graduate), use this form:


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