Students: Before completing this form, please log into McBurney Connect (“Student & Notetaker Login”) and choose “Information Release Consents.” Most release of information requests can be completed more quickly and easily through McBurney Connect.
The McBurney Center’s Authorization for Release of Confidential Information Form is a Word document that can be filled out by the student and submitted to the McBurney Center to obtain or send records when the release of information form in McBurney Connect cannot be used. The most common examples are to request copies of records from a clinician or to allow service providers to communicate with McBurney Center staff.