Health Services Records Request Form

Please read this consent form carefully and be sure you understand it before clicking the "Submit Form" button below.

You may use this form to permit the release to yourself or a third party any personal health information that Health Services has on file for you (for example immunizations). Your health records will be kept secure a minimum of 10 years at which point your records will be destroyed in accordance with legislation.

Your request for information has been submitted to Health Services. This may take up to 5 business days to process this request.

Please notify us of any changes to the information in your consent form. Thank you.

Return to Health Services

Personal information

If you have any difficulties completing this form, please email Health Services.

Forms

Version 2019.0288

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