RELEASE OF MEDICAL INFORMATION


To obtain copies of your immunizations or medical record please fill out and sign release of medical information. Please detail where you would like to records sent (to you or PCP office, etc.), including the address and fax number. Mail, fax (781.283.3693) or email (healthmd@wellesley.edu) it back to us. We'll fax (as it's faster) but if the records request are too large to fax, we will mail. We can not email medical record to you or anyone else- this is for your protection!

There will be a fee of $5.00 for immunizations and $15.00 for the complete medical record. Payment & form must be recived before we can release the records. You can mail a check with your form or fax/ email the form and call with your credit card info.

Your request will be processed within 5 business days.