Medical Information and Other Forms

Medical Information Forms

Authorization for Disclosure of Medical Information

An Authorization for Disclosure of Medical Information is an authorization for Harvard University Health Services to release your medical records to the parties you specify. A Release of Medical Information is used to have your medical records sent to...

Student Vaccine Exemption Form

Meningococcal Info Waiver

Miscellaneous Health Forms

Authorization to Disclose and Use Protected Health Information

Authorization to Treat a Minor

Parental consent for a minor to receive medical treatment from HUHS.

Consent to COVID Testing and Access to Information

Missed Appointment Fee Appeal Form

Appeal a missed appointment fee from Harvard University Health Services.

Advance Directive Forms – Health Care Proxy and Living Will

Health Care Proxy: Identify someone you know and trust to make health care decisions for you if you become unable to make those decisions Living Will: Provide specific written instructions for your future medical care.