Release Forms

Treatment of Minors

For students under 18 years of age, a parental or legal guardian authorization for medical treatment form must be on file in our office in order for you to receive prompt care and treatment, should the need arise. Please complete and return the Consent for Treatment of a Minor (PDF) form to:

UNI Student Health Clinic
016 Student Health Center
Cedar Falls, IA 50614-0021
     Or
email: healthcenter@uni.edu

To Request a Copy of Your Health Record:

You may use the request form Authorization for Release of Health Information (PDF) for a printable copy. All information must be completed in order for your request to be processed. Please complete and return the Consent to Release or Receive Medical Information (PDF) form to:

UNI Student Health Clinic
016 Student Health Center
Cedar Falls, IA 50614-0021
     Or
email: healthcenter@uni.edu

To Request a Copy of Your Mental Health Record:

You may use the request form Authorization for Release of Health Information (PDF) for a printable copy. All information must be completed in order for your request to be processed. Please complete and return the Consent to Release or Receive Mental Health Information (PDF) form to:

UNI Student Health Clinic
016 Student Health Center
Cedar Falls, IA 50614-0021
     Or
email: healthcenter@uni.edu


* Please allow 48-72 hours from receipt of a signed release for your health information records to be processed.