Email Consent Form
Authorize Apple Hills Medical Associates to communicate with you by email.
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Consent to Disclose Personal Health Information
Use the form below to authorize Apple Hills Medical Associates to release your personal health information to a designated individual or organization.
Download the Consent Form
Please download the PDF form below, complete it, and return it to our office in person or by fax.
Consent to Disclose Personal Health Information.pdf
Adobe Acrobat Document
Submit Your Completed Form
Once completed, return your form to our office. You may deliver it in person or send it by fax using the contact details below.
Apple Hills Medical Associates
- Address
- 1221 Bloor Street East, Mississauga, Ontario L4Y 2N8
- Phone
- (905) 625-1241
- Fax
- (905) 625-9514
Patient Resources
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Patients Overview
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