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Confidential Records Release Request

We are only able to provide your medical information to anyone, including your parents, with your written consent if you are age 18 or older.

In order to request a copy of your confidential records from Student Health Services (SHS), please complete the Authorization for Release of Confidential Information. In order to protect your privacy, the form must be notarized so we can verify we are releasing the information to the correct person. You can scan the notarized form and email it to SHS at, fax it to 850.857.6100, or mail it to:

University of West Florida
11000 University Parkway
Building 960 - Suite 106
Pensacola, Florida 32514

If you have any questions, please contact SHS at 850.474.2172.