Disclosure Authorization Consent Form
We understand that partners and family members often help manage healthcare needs. However, Ontario privacy laws require explicit, written authorization for a spouse, partner, or parent to act on behalf of another adult or a teenager (14+).
The Age of Consent (14 and Over): Per the Personal Health Information Protection Act (PHIPA), patients 14 years of age or older must provide their own consent for the team to discuss medical details or chart updates with parents or caregivers.
How to Authorize a Trusted Family Member or Friend
To grant permission for a family member or friend to communicate with us regarding your care, we offer two convenient options:
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Option 1: The Written Consent Form
Download, print, and sign the authorization form. Please bring the original document to our **Erin** or **Rockwood** clinic desks. Note: To protect your security, our team may contact you to verify forms delivered by a third party. -
Option 2: Documentation via Telephone (Quick & Easy)
Call us (Erin: 519-833-9396 or Rockwood: 519-856-4611) to verbally authorize a trusted person, which we will immediately log in your chart.
Managing Your Permissions: Authorized access remains active until you instruct us otherwise. You may update, limit, or remove this permission at any time by contacting our staff.
Download the Official Authorization Form
For a printable copy of the form, please access the document link below:
