Release of Information Form

The Release of Information Form enables Luther to release a student's medical records if he/she is referred to another physician, changes clinics, or moves. It is downloadable in the following format:

Portable Document Format (PDF)

This printable version is in a standard Portable Document Format (PDF). A recent version of Adobe Acrobat Reader should suffice to read or print this file.

Download the Release of Information Form: www.luther.edu/student-life/health-service/forms/release/documents/release.pdf (one-page pdf)