Release Forms

In accordance to HIPPA guidelines and to protect a patient's privacy, the following forms must be filled out and returned to the Health Center in order for our office to release any medical information.

If you are requesting immunization documentation, please click on the Immunization Release Form (PDF). Please fill out this form and either mail, fax or email the signed form to the R-MC Health Center.

If you need Medical Records (excluding immunizations) sent to another medical facility or records that need to be sent to to the Student Health Center, please use the Medical Release Form (PDF).

R-MC Student Health Center
P.O. Box 5005
Ashland, VA 23005

Fax: 804.752.3776