Health record requests
Student Health Services maintains medical records on all students for up to seven years after graduation. If you would like a copy of your immunization records, pap smears, other labs or complete medical record, you can go to the student health portal, https://connc.studenthealthportal.com, sign in, and see if you are able to access the information you need there. If you cannot access the information you need please fill out the Health Records Request Form and submit the appropriate payment due ($5 for immunization/ pap smear records; $20 for complete medical record). We advise all graduating seniors to obtain copies of their immunizations before leaving the College.
Additional forms for current/returning students
- SHS Health Record Request Form
- Acknowledgment of Financial Responsibility 2019-2020 (This form should be completed and submitted to SHS only if your waiver has been denied and you have an out-of-state HMO plan or have a Medicaid plan in Rhode Island, Massachusetts, or New York).
- Prescription Transfer Form
- Study Abroad Health Screening Form
- Consent to Treat Form
- State of Connecticut Religious Exemption Form
- SHS Authorization to disclose
- Online Waiver of Student Health Insurance - Consult the Insurance info page
- Club Sports Informed Consent Form (pdf)
- PreTravelHealthQuestionnaire(1) (for use after acceptance to program)
Counseling Services requests background information
- After making an initial appointment with Student Counseling Services, we request that all students fill out the needed background information forms. To access these forms, please go to the following URL: https://buttonbush.conncoll.edu/titanium_web/WCMenu.aspx. Once the page opens, click on the tab for "Intake." Again we ask that you please complete these forms prior to your initial appointment.
Confidentiality release for third parties
- Due to confidentiality laws and ethical practice standards, NO information is shared with anyone outside the SCS offices. If you require information to be shared with a third party, we will need you to complete the release of information form:
- Authorization to Disclose/Obtain Protected Health Information (PDF). If you have questions regarding confidentiality, please speak with your counselor at the time of your initial appointment or ask to speak with the director of student counseling services.