Forms
There are some forms that students can complete in advance of an appointment, which may save time!
- Before your first appointment: New Patient Package
- Before your Periodic Health Visit: Periodic Health Visit Form
- Before your annual physical/check-up: General Assessment Form
- Before your travel clinic appointment: Pre-Travel Information Form
- STI (Sexually Transmitted Infection) Assessment/Counselling: STI Assessment
- To sign up for web access: Web Access Form
- Before your first appointment, for international students: UHIP Consent Form
Other forms may need to be completed by your health care provider (either at the Health Service or in the community):
- Verification of Student Illness or Injury (previously Medical Certificate)
- Authorization For Release of Medical Information
- Medical Release Form for records coming to Health Services
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 a New Patient form, a Web Access Acknowledgement form and a Next of Kin Information form.Click here to view and download the New Patient Package (pdf)
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)
Pre-Travel Information Form
Please bring the completed Pre-Travel Information Form to the Health Service when you come for your Travel Medicine appointment.
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:
$40.00 for up to 40 pages and $1.00 per page thereafter up to a maximum of $60.
Xpresspost (with a tracking number) is available for an addition $15.00.
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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Click here to view the University Of Toronto Authorization For Release of Medical Information Form (In .GIF format)
If you are still unable to view or print the REGISTRATION FORM or the AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION, please visit or send someone on your behalf to University of Toronto Health
Service to pick one up.