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Stony Brook University Stony Brook University Student Affairs
Student Health Service

Record Release

In order to obtain a copy of your records, you must complete in its entirety an “Authorization for Protected Health Information”. 

DOWNLOAD the form HERE

The completed form may be sent to Student Health by mail or fax. A copy of a signature ID (such as a copy of your driver’s license) MUST be attached. Requests are processed in the order in which they are received. Please be aware once your request has been received, it will be processed within 10 business days    

Health records may be faxed only to a Physician’s Office or a University Health Office.  All other requests will be sent by mail.

Please be specific in your request, a request for release of full medical records may incur a per page charge as well as may delay receipt.

 

 

Title IX prohibits sex discrimination in all forms, including sexual violence and/or harassment. 
Contact Raul M. Sanchez, Senior Director for Title IX and Risk Management, Office of the President, 310 Administration Building, 
Stony Brook University, Stony Brook, NY 11794-0701, raul.sanchez@stonybrook.edu (631)-632-6975
See www.stonybrook.edu/titleix for more information and/or to report an incident.