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Majors and Minors
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Medical Records Release Form
Medical records are stored for 10 years after graduation.
Cell phone number
Graduation year/ Last year as an employee.
Full name while attending Wofford
Date of Birth
I request that a copy of the following information contained in my medical record to be:
Please check records to be released or obtained
I wish to exclude the release of theses items and confirmation pertaining to:
An unaltered photocopy of this document may be accepeted in lieu of the original and I understand that the original will be maintained in my records.
This authorization will remain in effect until this request is processed.
This authorization will remain in effect until:
By clicking this box, I consent to the release of my medical information.
Optional Modal title