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Forms, Policies and Fees

Forms

You can save time at your appointment by filling out and printing your forms ahead of time. Every student is required to fill in an Intake and Consent form. Not sure what other forms you need? Give us a call at 902-494-2171 (Halifax) and 902-893-6300 (Truro).

Intake & Consent Form [PDF]
Print your Intake and Consent Form for the Student Health & Wellness Centre

No Show Waiver Request Form 
Request to have your appointment cancelation fee waived.

Records Transfer Form
Request to have your medical or counselling records transferred

Shared Records Consent Change Form [PDF]
Request a change of preference in the sharing of your own personal health records

DSU International Insurance Plan Authorization & Assignment of Payment Form [PDF]
Authorize the Dal Health & Wellness on your behalf, to submit claims and obtain payments for all services performed for you, your spouse and your dependents during the Coverage Period.

Written Privacy Statement [PDF]
FAQs for access to patient information and the Personal Health Protection Act

Request for User Activity [PDF]
Request a record of user activity from Dal Student Health & Wellness

Request for Access [PDF]
Request access to your own personal health records

Complaint Form [PDF]
Submit a formal complaint about Student Health & Wellness

Student Declaration of Absence [PDF]
Declare your absence for late academic requirements

Student Referral Form
Refer a student to Dal Student Health & Wellness

Cancellation Policy

Our cancellation policy applies to medical appointments with our doctors and our psychiatrist. There is no fee for a missed appointment with our social worker, counsellors, or registered psychologist, but 24 hours' notice is still appreciated for cancelling an appointment, to ensure the appointment can be filled by another student in need. 

To cancel your appointment, call 902-494-2171 (Halifax) or 902-893-6300 (Truro). 

Cancellation Fees 

  • More than 24 hours before - No fee
  • Less than 24 hours before (doctor) - $40 
  • Less than 24 hours before (psychiatrist) - Minimum of $100
  • No show (doctor) - Minimum of $40 
  • No show (psychiatrist) - Minimum of $175