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Medical Authorization Forms (Records)

If you are requesting your records from Fitchburg State University be faxed to another facility, please download and complete the following form and fax it to us at 978-665-3641.

Authorization for Medical Records from Fitchburg State (PDF)

If you are requesting a medical provider or another institution to forward Fitchburg State University your medical records then please complete this form.

Authorization for Medical Records to Fitchburg State (MS Word)