Patient Email Consent Form
Before communicating with our office by email, please review the important information below and submit your signed consent form.
Important Information
Email Communication Guidelines
In order to communicate with our office via email there are some limitations on how we can communicate with you by email, which we will explain here.
Consent to Respond
When you contact us via email you give Apple Hills Medical Associates permission/consent to respond to your email which may include your Personal Health Information.
Not a Substitute for Clinical Assessment
Email communication is not a substitute for clinical assessment. Although technology is changing, the best way to share information with your health care provider is in person.
Not for Emergencies or Time-Sensitive Issues
Email communication should not be used to communicate emergencies or time sensitive health care issues. If you are experiencing an emergency, you should call 9-1-1 or go to the nearest hospital immediately.
How to Submit Your Form
Please print the attached form, sign and either bring it in to our office at your next Doctor's appointment or it can be mailed to 1221 Bloor Street East, Mississauga, Ontario L4Y 2N8.
Your Next Step
Download, Sign & Return Your Form
Print the form below, sign it, and either bring it to your next appointment or mail it to our office.
Mail Completed Form To:
Apple Hills Medical Associates1221 Bloor Street East
Mississauga, Ontario L4Y 2N8
Questions?
Contact Our Office
If you have any questions about the email consent process, please don't hesitate to reach out to us directly.
Phone
(905) 625-1241Fax
(905) 625-9514
Address
1221 Bloor Street East, Mississauga, Ontario L4Y 2N8