Student Health Center Immunization Record Request Form

This online record request form can only be used for immunization record requests. For all other record requests, please call the front desk at 660-785-4182.

If you are a current Truman student and are requesting records, you can come to the Student Health Center in person and pick up a copy with no charge.

The record release request form below must be completed and submitted to the Student Health Center before any records will be released to yourself or another source. Allow up to three to five business days for your record request to be processed. Record requests make take longer when classes are not in session, because staffing is reduced at that time. Requests are processed in the order they are received at the Student Health Center. A clerical fee of $5.00, paid through Truman’s secure online payment system, is due at the time of your request.

Record release requests must be submitted through this online form, unless you do not own a personal computer or have regular access to a computer with Internet connection. In the event of these circumstances,

  1. You may obtain a hard copy of this form at the front desk at the Student Health Center.
  2. You may call the SHC at 660-785-4182 and provide a fax number for a hard copy to be faxed to you.
  3. Then, fax the provided form to 660-785-4011 or mail it to Truman State University Student Health Center, 100 E. Normal, Kirksville, MO 63501.

Please note that hard copy record release requests submitted in person or via fax are processed under the same guidelines as online requests. Due to the large volume of record requests, there are no exceptions to these guidelines.

Records for former students are only maintained for seven years. Records of immunizations given by the Student Health Center will be maintained longer. Do not request records for immunizations not given by the Student Health Center that are older than seven years. Refunds of electronic payments cannot be given for requests for records that have been destroyed.

Have you ever been seen as a patient at the Health Center?




If you are a current Truman student and are requesting records, you can come to the Student Health Center in person and pick up a copy with no charge.

I give permission to the Truman State University Student Health Center to release the following records:


I would like my records

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Address my records to


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Required Field Asterisk Indicates required fields for submission of record request.