Accommodation for Medical Illness and Obtaining a Medical Certificate

Western requires documentation from the medical community for students who require academic accommodation due to medical illness. Students are required to have their physician or health care provider fill out a Student Medical Certificate.

If you require this documentation from Student Health Services:

  • The request for a medical certificate should be made during the initial visit with the SHS physician or nurse practitioner.
  • The fee for having this form completed is $20. You may pick up the completed form and make your payment in the Accounts Office (Room 19) at SHS.
  • Medical certificates will only be considered for students who are seriously affected by illness and cannot reasonably be expected to meet their academic responsibilities. Medical certificates may NOT be issued for minor illness like colds, non-acute vomiting or diarrhea, menstrual cramps, insomnia or for past illnesses not seen at Student Health Services.
  • If the requested accommodation is related to a death in the family, please see your academic counsellor.

Please read the Accommodation for Medical Illness Undergrad policy.

Clinic Consent Form

All students accessing Student Health Services are required to sign a Clinic Consent Form which is kept on file. When you register at your first appointment for medical services or counselling, you will receive a copy of this form.

No Show, Cancellation Policy and Applicable Fees

Student Health Services (SHS) requires 24 hours of notice to cancel an appointment. A fee will be charged in cases of lateness, missed appointments, or not giving adequate notice. In the case of appointments cancelled the same day or within 24 hours, you will be billed for a cancellation charge. Monday appointments must be cancelled by the end of the work day on Friday to not be billed for a missed appointment. The fee is determined by the type of appointment that was booked. Failure to pay the charges within 30 days will lead to the sealing of your academic records and an additional $50 administrative fee. SHS attempts to remind patients of their appointments, but it remains the student's responsibility to ensure an appointment is not missed.

Health Service or Physician Fees [No Show or Late Cancellation Charges]:



No Show - Minor


No Show - Intermediate


No Show - Female Physical


No Show - Male Physical


No Show - 3rd Party Physical


No Show - Wart Tx (minor + cry...


No Show - Counselling - 20 min...


Psychiatric Consult No Show


No Show - other


GP Consult No Show


No Charge


No Show Pap Visit


No Show - Minor




Fee Schedule is consistent with OMA guidelines.

Privacy Policy

Health Services at Western is responsible for personal information under our control and has designated the Director of Health Services as the contact person for compliance with the Personal Health Information Protection Act (PHIPA) under Ontario law based on 10 privacy principles.

Principle 1. Accountability for Personal Health Information
  • The Director of Health Services is both Privacy Officer and contact person for privacy matters.
  • Western Student Health Services endeavours to be compliant with PHIPA by ensuring procedures to protect personal health information;
  • SHS responds to complaints and inquiries;
  • Staff and affiliates are educated about privacy policies and practices including the inappropriate release of personal health information outside the circle of care.
Principle 2. Identifying Purposes for the Collection of Personal Health Information
  • Health Services at Western will identify the purposes for collecting health information by means of posters, brochures and web site;
  • The primary purpose of collecting, using and sharing personal health information is to deliver patient care. We also use information for administrative purposes, research, teaching, statistics, fundraising, and to comply with our legal and regulatory requirements.
Principle 3. Consent for the Collection, Use, and Disclosure of Personal Information
  • We rely on implied consent for most patient care, but will seek your written consent for other purposes e.g. identifiable information used for research.
    Patients have the right to know why we are collecting their information and how it is being used; patients may also withdraw their consent at any time, unless the collection, use or sharing is required or permitted by law
Principle 4. Limiting Collection of Personal Health Information
  • Only the information necessary for the purposes identified may be collected.
Principle 5. Limiting Use, Disclosure, and Retention of Personal Information
  • Personal health information may be used only for the purposes for which it was collected, except with patient consent or as required by law. The information is retained only as long as necessary, and securely destroyed in accordance with legislation, guidelines and procedures. HS staff and physicians are not allowed to download patient health information to USB keys, laptops or other personal devices.
Principle 6. Ensuring Accuracy of Personal Health Information
  • Health Services at Western will make every effort to ensure the information we hold is accurate, complete and up-to-date. Patients have the right to challenge the accuracy of the information.
Principle 7. Ensuring Safeguards for Personal Information
  • Health Services at Western applies security safeguards appropriate to the sensitivity of personal health information to aim to protect it against loss, theft, unauthorized access, disclosure, copying, use, or modification, regardless of its format. Protection may include physical measures, organizational limitations, and technological measures (use of passwords, encryption and audits). If any staff members are aware ofunauthorized disclosures of health information, the Director of HS is to be notified immediately. Staff are not to download patient information or transfer information. Procedures for remote access are to be strictly followed.
  • Staff/physicians/work study students are required to sign a confidentiality agreement and instructed to use the internal electronic medical record system for communication regarding patient information rather than email; hard copy redundant files are to be cross-shredded as approved by the Director; faxes are secure with information unavailable to unauthorized individuals.
Principle 8. Openness about Personal Information Policies and Practices
  • Health Services at Western posts their privacy policy at registration and other public clinic areas and their website. The poster includes the contact person information for inquiries and a description of the type of personal health information held and how it is shared.
Principle 9. Individual Access to Own Personal Information
  • Upon request, within a reasonable time and at a reasonable cost, any patient can access their health information .Exceptions to providing access will be limited and specific. This may include information that is prohibitively costly to provide, refers to other individuals, cannot be disclosed for legal, security or proprietary reasons, and/or is subject to solicitor-client or litigation privilege.
Principle 10. Challenging Compliance with Health Service's Privacy Policy and Practices
  • An individual may challenge the clinic's compliance with privacy practices by contacting the Director of Health Services, on campus at health@uwo.ca. The Director will investigate all complaints.
  • If a complaint is justified, Student Health Services at Western will take appropriate measures, including, if necessary, amendment of policies and practices.
  • The Ontario Privacy Commissioner may be contacted at 1-800-387-0073.

Self-Reported Absence Form

Students who experience an unexpected illness or injury or an extenuating circumstance (48 hours or less) that is sufficiently severe to temporarily render them unable to meet academic requirements (e.g., attending lectures or labs, writing tests or midterm exams, completing and submitting assignments, participating in presentations) should self-declare using the online Self-Reported Absence portal.

Please review the information on the Office of the Registrar website under "Self-Reported Absence Form".