Seattle University Student Health Center
I request and authorize the Seattle University Student Health Center to ( obtain from. or ( disclose to (check the appropriate box) the following entities my health care information: ( Seattle University Disability Services: Phone: 206-296-5740, Fax: 206-296-5747 ( Seattle University Athletic Trainers: Phone: 206-296-5452, Fax: 206-296-2154 ( ................
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