ALVERNIA UNIVERSITY HEALTH AND WELLNESS CENTER - alvernia 2025

1. Click ‘Get Form’ to open the Authorization to Release Medical Information form in our editor.
2. Begin by entering your full name in the designated field at the top of the form. This identifies you as the student authorizing the release.
3. Next, input your Student ID number. This is crucial for linking your health information with your academic records.
4. Provide your signature in the appropriate section. This confirms your consent for the Health and Wellness Center to share your medical information.
5. Fill in the date of signing, ensuring that it reflects when you completed this authorization.
6. If known, specify your internship site in the provided field. This helps direct your health information appropriately.
7. Lastly, indicate your major to assist in processing and categorizing your request effectively.

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