**more information and forms coming soon**


Requesting Medical Records

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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 in the processing of your request. Please allow two (2) weeks for records to be sent. 


Return from Leave Medical Information Form

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.

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Forms for PSIP (Penn Student Insurance Plan)


Aetna Claim Form

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Aetna Prescription Drug Claim Form

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Aetna Prescription Home Delivery Order Form

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