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All the health forms!

Last updated May 23, 2024

We have collected all the forms in one place for you to ensure your visit to Health and Wellness is time well spent. Please fill out the appropriate form before your appointment. Additional details can be found in the ASSOCIATED SERVICES section of this page.

New! Fill out and sign forms digitally, then email the completed form(s) to us at admin.hwc@utoronto.ca. Your signature is required in order for you to receive care from Health & Wellness.

The form(s) on this page are fillable PDFs. Download the file, complete the form and save it to your computer before emailing it to Health & Wellness. Having trouble? Watch this YouTube tutorial if you’re using Adobe Acrobat Reader, or this YouTube tutorial if you’re using a Mac (no additional software necessary).

Bring your T-Card, Ontario Health Card (OHIP), other Canadian Provincial Health Card, or a printout of University Health Insurance Plan (UHIP) to every appointment.

  • Registration Package (formerly New Client Form): Please call 416-978-8030 (Monday – Friday, 9 a.m. – 4:30 p.m.) to register as a new patient before your first appointment. Our reception staff will email the Registration Package through a secure online portal.
  • Registration Package for International Students (formerly New Client Form for International Students): Please call 416-978-8030 (Monday – Friday, 9 a.m.– 4:30 p.m.) to register as a new patient before your first appointment. Our reception staff will email the Registration Package for International Students through a secure online portal.
  • Client Record Form: to complete before your first Mental Health Screen / Assessment.
  • General Assessment Form: to complete before your general assessment.
  • IUD Insertion Form: to complete before an IUD (Intrauterine Device) insertion.
  • Allergy Immunotherapy Intake Form: (for a student to bring to an allergist for completion) to provide clarity about allergy regimen and protocol for a currently registered U of T student receiving allergy care at Health & Wellness.
  • Psychiatry Referral Form: (for a physician) to refer a currently registered U of T student to Health & Wellness for brief episodic psychiatric care.
  • Same-Day Counselling Form: to complete before your same-day counselling appointment. Email the completed form to mentalhealth.hwc@utoronto.ca.
  • Counselling Form: to complete before your same-day counselling appointment IF you have had a same-day counselling session before. This is a shorter form. Email the completed form to mentalhealth.hwc@utoronto.ca.
  • Periodic Health Visit Form: to complete before your periodic health check-up.
  • Pre-Travel Information Form: to complete before your travel clinic appointment.
  • Medical Release Form to Health & Wellness: to authorize the Health & Wellness Centre to obtain your health records from other healthcare professionals.
  • Medical Release Form from Health & Wellness: to authorize the release of your health record from Health & Wellness.
  • Verification of Illness Form: if you need a healthcare professional to verify that you have been ill or injured.