Sending Medical Records

Completed Medical Records  assure we are meeting Massachusetts state public health regulations and  inform the health care you receive at Brandeis Health Center. Failure to complete the medical records may result in a hold on your course registrations. Medical Record forms must be faxed or mailed to the attention of Brandeis Health Center as directed. If faxing, Please wait for your fax transmittal confirmation as we cannot personally verify all received faxes. We will contact you via your brandeis email account if your records are incomplete. If you have questions or concerns please contact us  by calling 781-736-3677 or emailing brandeishealthcenter@brandeis.edu

HEALTH FORMS

Health Records are required once, upon matriculation into a degree granting program. These records allow us to meet state public health regulations as well as inform your medical care as a patient of Brandeis Health Center. Your records are kept as confidential health records. Records may be downloaded and sent via mail service directly to the health center at 415 South Street MS034, Waltham, MA 02454 or via our dedicated fax line at 781-736-3675.

Complete Undergraduate Health Record

Complete Graduate Health Record

Meningococcal Waiver Form

General Agreement Form

Patient Rights and Responsibilities

Notice of Privacy Practices -Clinical care records for Brandeis Health Center services are  kept in paper format at Brandeis Health Center. Copies  can be requested using the following form:

Medical Record Release Form

Health Center  |  Stoneman/Golding Building  |  415 South Street, MS 034, Waltham, MA 02454

Telephone: 781-736-3677  fax 781-736-3675  email (non urgent) brandeishealthcenter@brandeis.edu