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. Authorization forms for release of information may be obtained below or at the Student Health office.

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)

Please be aware your medical information is now physically located in another building and it may take up to a week for us to retrieve and mail your information to you.

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


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