Canada has several Privacy Acts which protect patients from unreasonable release of personal information, ensure security of patients' records and guarantee a patient reasonable access to their files. The Optometrists' Clinic endorses those Acts, and all employees are obligated to protect patients' privacy.
Personal information collected from patients of this practice shall be limited to that required to:
1. Evaluate Your Health and Vision Status
2. Determine and Recommend Appropriate Treatment or Referral
3. Communicate with You about Services We Provide
4. Provide You with Eye Care, Health or Other Product or Treatment Information
5. Process Payment for Services and Products Received from Our Office
6. Communicate with Others about Your Health and Vision Status
I understand that patient information will only be released to other parties with relevance to my case.
Patient Signature ___________________________________
The Optometrists' Clinic does not sell, give or otherwise distribute personal information to unauthorized parties.