RELEASE OF MEDICAL INFORMATION


To obtain copies of your immunizations or medical record:

  1. Complete and sign release of medical information. Please detail where you would like the records sent to (yourself, PCP office, etc.), including the address and fax number. 
  2. Mail, fax (781.283.3693) or email (healthmd@wellesley.edu) it back to us (must have your actual signature- not typed in). We'll often fax them because 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.
  3. Set up payment (no charge if your a current student). There is 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.