Forms

There are some forms that students can complete in advance of an appointment, which may save time!

 

Other forms may need to be completed by your health care provider (either at the Health Service or in the community):


New Patient Package

Students who have never been to the Health Service should print, complete and bring these forms to their first appointment at the clinic. The forms include a New Patient form, a Web Access Acknowledgement form and a Next of Kin Information. All International Students should click on the 2nd link.

Click here to view and download the New Patient Package 

 

Click here to view and download INTERNATIONAL STUDENT New Patient Package

 


Consent Form for International Patients International Students with UHIP (University Health Insurance Plan) need to complete a consent form and submit it when they check-in for their first appointment at the clinic.

Click here to view and download UHIP Authorization Form



Health Assessment Questionnaire


Please complete and print this form in advance of your appointment for a Complete Physical Exam and bring it with you to your appointment.
 

Click here to view the General Assessment Form (pdf)

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 Pre-Travel Information Form


Please bring the completed Pre-Travel Information Form to the Health Service when you come for your Travel Medicine appointment.

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 Authorization For Release of Medical Information
 

This form will permit Health Services to release necessary medical information to a specific recipient. Complete the form and submit by: (1) email: health.services@utoronto.ca (2) fax: 416-971-2089 (3) drop off at Accounts window in Health Services. Please note the fee must be paid before the request is processed.

Medical Records Fee:
$30 for up to 20 pages and $0.25 per page thereafter.

$5.00 charge for postage and handling  (additional postage charges may apply for US and International mailing).

Xpresspost (with a tracking number) is available for an addition $15.00.

 


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Problems and Troubleshooting


In order to view and print these forms, you must use a .PDF file viewer.  We recommend that you install one of these free viewers:


If you do not have an Acrobat .PDF file viewer, or are experiencing problems attempting to view any of these forms, then please click on the appropriate link below to view a .GIF version of the medical certificate (please note, the Acrobat .PDF version has better quality and prints out better, so we recommend that you try downloading those first before trying these).

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www.illnessverification.utoronto.ca/