To release your medical information to someone other than yourself, please fill out the following form:
Permission for Release of Medical Information
After printing, filling out, and signing the Release of Medical Information form, please scan it back in to your computer and fax or email it to us.
Fax: (501) 205-8708
Email: shc@uca.edu
The Student Health Clinic will not disclose your confidential medical information to anyone unless YOU give your written permission for us to do so. This means we will not tell your roommates, your friends, the faculty, staff, or even family members about any of your appointments, phone calls, or visits with our providers/staff unless we have received a signed copy of the release form linked above.