Last updated December 13, 2022
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 firstname.lastname@example.org. 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.
- New Client Form (formerly New Patient Package for Domestic 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 New Client Form through a secure online portal.
- New Client Form for International Students (formerly New Patient Package 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 New Client Form 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.
- UPDATED! Psychiatry Referral Form: (for a family physician) to refer a currently registered U of T student to Health & Wellness for brief episodic psychiatric care.
- UPDATED! Same-Day Counselling Form: to complete before your same-day counselling appointment. Email the completed form to email@example.com.
- NEW! 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 firstname.lastname@example.org.
- Personal Health Visit Form: to complete before your personal health check-up.
- Pre-Travel Information Form: to complete before your travel clinic appointment.
- STI Assessment Form: to complete before your sexually transmitted infection (STI) assessment/counselling 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.
Personal health visitA health check-up, more formally known as periodic Personal Health Visit (PHV), replaces the annual physical examination. Learn more about Personal health visit
Electronic medical records and appointment booking systemHealth & Wellness provides an electronic medical records (EMR) system for both U of T students and health-care professionals to to book and confirm appointments, deliver confidential information including lab results and more. Learn more about Electronic medical records and appointment booking system
Disability documentationIf you do not have a family physician or a care provider and you require disability documentation for academic accommodations, we may be able to help. Learn more about Disability documentation
Mental health clinical servicesIf you're looking for mental health services, Health & Wellness offers a variety of options to suit your needs. Learn more about Mental health clinical services
Sexual and reproductive health counselling and educationThe physicians and nurses at the Health & Wellness Centre can provide counselling and information on the various forms of birth control, and can help you choose the method that is right for you. Learn more about Sexual and reproductive health counselling and education
Immunization servicesWe offer free vaccinations for diphtheria, polio, tetanus, mumps, measles and rubella. Other immunizations are available for a fee. Learn more about Immunization services