Health care providers must have your written consent to share your personal health information. There are two authorization forms available. Use the form appropriate for your circumstance:
- Release from Health & Wellness to another health care provider, or
- Release from your healthcare provider to Health & Wellness
Release from Health & Wellness
If you require any of your medical information to be released from Health & Wellness to another person e.g. your healthcare provider in the community or agency, complete the Medical Release Form from Health & Wellness (PDF). This form will permit Health & Wellness to release necessary medical information to a specific recipient.
Release from your healthcare provider
If you require any of your medical information to be released from your healthcare provider, e.g. your own family physician, or agency to Health & Wellness, complete the Medical Release Form to Health & Wellness (PDF). This form will permit Health & Wellness to receive necessary medical information to support your care.
- Full-time and part-time University of Toronto undergraduate and graduate students who have paid the appropriate incidental fees.
- Toronto School of Theology undergradate students at Emmanuel College in the conjoint full-time basic degree program.
- Students in the School of Continuing Studies English Language Program (identified by a student card).
Read the full Health & Wellness Eligibility Policy.
The following fees are associated with your Authorization of release of medical information from Health & Wellness to another person or agency.
- CDN $30 for up to 20 pages and CDN $0.25 per page thereafter
- CDN $10 charge for postage and handling (additional postage charge may apply for US and International mailing)
- Xpresspost shipping (with a tracking number) is available for an additional charge (minimum CDN $15)
Complete the relevant form and submit by either:
- Email: firstname.lastname@example.org
- Fax: 416-971-2089
- Drop off in person at the Accounts Office in Health & Wellness (214 College Street, 2nd Floor)
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