Authorization For Release of Medical Information

This form will permit the Campus Health Centre to release necessary medical information to a specific recipient.

The form is available in the Campus Health Centre and can be submitted by either:

(1) Fax: 905.721.3133

(2) Drop off in the Campus Health Centre at the reception desk.

Please note the fee must be paid before the request is processed:

  • $30 for up to 20 pages and $0.25 per page thereafter
  • $5.00 charge for postage and handling (additional postage charges may apply for US and International mailing)
  • Xpresspost (with a tracking number) is available for an addition $15.00