Email Consent Form

I have read or been provided with the Thornhill Village Family Health Organization’s policy on the use of email for the transmission of personal health information. In consenting to the use of email with my physician and his/her staff I declare that the email address I provide is private and accessible only by me. I understand that emails are not checked daily and that if there are any urgent issues that require attention I will call the office for advice or an appointment.

By completing this form, I acknowledge that I have read and consent to the use of email for communicating with my physician and Thornhill Village FHO staff.

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