Skip to main content

The following forms may be needed when seeking support through Student Health and Counseling:

Request Medical Records

Please fill out the request form in its entirety, including the special records section and chose one way to have them sent to you. If a form is not completely filled out, we will need to contact you which may delay the processing of your request. Please allow two weeks for records to be sent.

Medical Services: Return from Leave of Absence

If you have taken a Leave of Absence as a result of a medical condition and are ready to return to academics, please fill out this form and have your medical provider(s) complete and sign the form. The medical provider(s) must be the clinicians who are currently treating you for the condition.

Counseling Services: Return from Leave of Absence

All requests to return from a leave of absence begin with your academic advisor. After you make contact with your advisor, you may be directed to Student Health and Counseling (counseling services) as part of the return from leave process. If you require our involvement in this process, please fill out the form and work with your provider to submit.

Forms for PSIP (Penn Student Insurance Plan)