New Patients

Forms to fill out and sign:

Domestic Students:

1. Consent to use virtual communications
2. Student Wellness Centre Confidentiality Agreement

International Students:

UHIP Insurance:

1. Consent to use virtual communications
2. Student Wellness Centre Confidentiality Agreement
3. Governing Law Agreement
4. UHIP Claim form (Only sign and date Section 3 on the top of page 2. Do not tick any boxes)
5. UHIP Claim Authorization Form 

COWAN Insurance:

1. Consent to use virtual communication
2. Student Wellness Centre Confidentiality Agreement
3. Governing Law Agreement
4. Cowan Provider Submission form and Assignment of Benefits

Instructions for signing and returning forms to Trent Student Health Services:

1. If you have a printer and scanner and/or fax machine:

•  please fill out the fillable PDFs indicated above, print, sign and either scan and email back to healthservices@trentu.ca via your trentu email or fax to 705-748-1055.

2. If you have a printer and no scanner/fax:

• please fill out the fillable PDFs indicated above, print, sign and email either a picture or a PDF (preferred) to healthservices@trentu.ca via your trentu email.

Instructions to save a picture as a PDF:

Android Devices:

1. Choose Pictures from your device.
2. Click on Convert button.
3. Wait for processing it will not take long time.
4. Click on Download button and download your Converted PDF file.

OR

1. Open Google Photos.
2. Select an image.
3. Select the : menu > Print.
4. Select the drop down menu from the top and select Save as PDF.
5. Name the file and select Save to download the image to your Android phone.
6. Repeat for each image

iPhone Devices:

1. Open the Photos app and choose the picture you want to convert to a PDF
2. Tap on the Sharing button and then choose “Print” from the sharing option action menu
3. At the Printer Options screen, use a spreading gesture on the photo preview to access the secret Save PDF option
4. Choose to share the converted photo as PDF via Message, Mail, placing it into Notes or another app, or choose “Add To iCloud Drive” to save the converted photo as PDF to iCloud

OR

Alternately, there are third-party apps you can use to upload images to create a PDF.  We cannot offer any recommendations but you can research to see if one fits your needs while respecting image privacy and security

3. If you do not have a printer.

• You Can fill out the fillable PDF and use one of the following apps to sign it electronically:
  • Secured Signing (Web-based, not for mobile phones. First 3 documents/month are free for one user)
  • Adobe Sign (Mobile app – 14 day free trail)

4. If there are barriers to following the instructions above:

•  Fill out the PDFs electronically.
• Type your name in the signature section.
• Save them to your device and email a copy via your trentu email to healthservices@trentu.ca with the statement:  Please review the attached _______Form(s). I confirm I accept the terms of the _______ Form(s)