USC - PurpleCARE - myvirtualdoctor - Opt-Out Form

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24/7 Virtual Health Care Access myvirtualdoctor is your go-to online healthcare companion! Offer unlimited access to healthcare professionals.

Opt-Out Applications

Submit your myvirtualdoctor opt-out application before the deadline.

Fall Application Period

August 1^st, 2024 to September 23^rd, 2024 at 11:30 PM

Make sure to submit your form by September 23^rd as the online form won't be accessible after that date.

Eligibility Criteria

Students can opt-out of myvirtualdoctor based on their personal choice by the applicable deadline.

Once you opt-out you will not be able to re-enroll in the Virtual Health Care - myvirtualdoctor until your enrollment anniversary.

Important notes:

The student is given one (1) opportunity to opt-out of myvirtualdoctor each year. The student is only able to opt-out during their initial opt-out period or the opt-out period that corresponds with their enrolment anniversary.
Approval of the Student’s opt-out will result in the myvirtualdoctor fee being credited/or refunded according to the school's policy.
The myvirtualdoctor opt-out is an annual opt-out. You will be re-enrolled next year on your enrolment anniversary and if you wish to opt-out again you will need to complete a new online form prior to the applicable deadline.
NO EXCEPTIONS will be made if the deadline is missed. It is the student's responsibility to pay the plan's mandatory fees, should they miss the applicable opt-out deadline.
Once you complete the opt-out form, you will receive an automated email confirmation. Please keep this email for your records as it is your only proof of submitting an opt-out request.

Add donotreply@gallivan.ca to your address book. Please do not reply to this email.

Questions? Please contact your Benefit Plan Office: healthdental@westernusc.ca

myvirtualdoctor Opt-Out Form

Students must use their Western Provided Student ID number. Your student ID can be located in your student centre account or your Western One Card.

Please complete all information on the myvirtualdoctor opt out form and we will process your application as soon as we can.

Student Information

Student ID Number

Email Address

Confirm Email Address

First Name

Last Name

Date of Birth

Date Month Field Date Day Field Date Year Field

Postal Code

Phone Number

Phone Area Number Phone Local Number Phone Digits

Opt-Out Applications

Fall Application Period

Eligibility Criteria

The fall 2023 myvirtualdoctor opt-out deadline is closed.

myvirtualdoctor Opt-Out Form

Student Information

Required Direct Deposit Information

Benefits Plan Office

General Inquiries Line

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