Please complete and print this form in advance of your appointment for a Complete Physical Exam and bring it with you to your appointment.
Please bring the completed Pre-Travel Information Form to the Health Service when you come for your Travel Medicine appointment.
This form will permit Health Services to release necessary medical information to a specific recipient. Complete the form and submit by: (1) email: firstname.lastname@example.org (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.
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).
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.