Medical Records & Forms
The mission of Medical Records is to maintain complete and accurate medical records, to safeguard all information against loss and use by unauthorized persons, to maintain medical records in a manner permitting prompt retrieval, and to assist Health Services staff and patients as necessary.
To request medical records for yourself or another provider/health facility:
Print, complete, and sign a copy of the Release of Information or Medical Records form and submit the completed form to CSULB Student Health Services by e-mail, mail, fax, or in person. Note: If you are a current student, some of your records may be available in the patient portal.
Printable Medical Forms
Ways to Submit your Completed Forms
- By E-mail
- Please e-mail the completed form to SHS-MedicalRecords@csulb.edu.
- By Mail
Please send the completed form to:
CSULB Student Health Services
Attn: Medical Records
1250 Bellflower Blvd. MS 0201
Long Beach, CA 90840
- By Fax
- Please fax the completed form to our secure Confidential Fax Line at 562.985.1644.
- In Person
- You can also submit the form in person at the Student Health Services by checking in at the front desk.
- For questions, please call Medical Records at 562.985.4176 or e-mail SHS-MedicalRecords@CSULB.edu.
Advanced Directive Information:
