Forms and Policies

Medical Record Release Forms

All medical information is confidential and will not be released without written, informed consent. To obtain your medical information from Student Health Services, or to allow your medical information to be sent to Student Health Services, please print, complete, sign and send the applicable form. Requests for medical records require a minimum 7-10 business days to process. SHS will not send information to a non-encrypted email account. Students who have visited SHS are able to view many of their own records in their Northwestern MyChart account.

• Form to Request Copy of Medical Records (PDF) - This form allow Student Health Services to release requested records to you or to a person/ place that you specify. This is not to be used by parents or guardians to view their student's health records. Please refer to the Privacy Notice Packet.
• Authorization to Release Patient-Related Information TO Wheaton College (PDF) - This form allows an outside provider/clinic to release requested medical records to Wheaton College Student Health Services.
• Privacy Notice- This form is specific for while students are at Wheaton College, regarding privacy laws, billing practices and permission to speak with listed individuals. (Minors cannot fill this out until they turn 18. See below policy for minors.)

 

• Policy Regarding Minors (PDF)
• Patients Rights and Responsibility
• Appointment Policies
• Immunization Exemption Policy
• Health and Wellness Fee
• COVID