Authorization to Release Health Record

New York State Law requires medical records to be kept on file for six years after a student graduates or departs from an educational institution. All medical records are destroyed after six years.

Student's immunization records have been electronically maintained and may be released when a Authorization to Release Medical Information form is completed and signed by a former student. Please print and complete the form from above link and mail it with payment to the Health Center.

If authorizing and paying by credit or debit card online, please click here to complete and submit the form.


There is $5.00 processing fee. After reception of payment, the requested immunizations record will be released to the designated recipient.

Process may take up to a week before designated recipient receives the immunizations record.