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University Health Services UC Berkeley 2222 Bancroft Way, Berkeley, CA 94720 510.642.1804 Fax: 510.642.1801 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION Withdrawal Committee Please fully complete
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Visit the university health services website or office to obtain the necessary forms.
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Fill out personal information such as name, date of birth, and contact details.
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Provide information about your health insurance coverage, if applicable.
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Sign and date the form once all the required sections have been completed.
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Submit the completed form to the designated university health services department.

Who needs university health services uc:

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Students enrolled in the university who require medical attention or healthcare services.
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Anyone on campus seeking advice or information about health-related issues or concerns.
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University Health Services UC is a campus health center that provides medical services to students, faculty, and staff of the university.
Students, faculty, and staff of the university are required to utilize the services of University Health Services UC.
To utilize University Health Services UC, individuals can schedule appointments online, walk-in during operating hours, or call to make an appointment.
The purpose of University Health Services UC is to provide accessible and quality healthcare services to the university community.
Information such as medical history, symptoms, insurance information, and other relevant details must be reported on University Health Services UC.
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