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.
If you have any difficulties completing this form, please email Health Services.
Online forms (some public) that interface with in-house applications when submitted.
Framework Version: 4.0.14, Running on NDADAPPWEB03
Designed and built by Enterprise Applications, Information Technology Solutions, RRC Polytech
To log out of Forms, simply close this browser tab.
This does not log you out of all RRC Polytech applications, only Forms.