Personal Information Collection Statement

Provision of the information requested on this form is voluntary. We will use your personal information for the following purpose(s):

  • The information is being collected to provide additional information requested by you.

Authority to collect information contained on this form for the purposes described above is administered under the Information and Privacy Commissioner of Ontario , which states that you have the right to access your personal information and request changes to incorrect information. If you wish to avail yourself of this right or require clarification about this Statement, contact our Privacy Coordinator by calling 905-723-8551, or write to:

Access to Information and Privacy Coordinator
Oshawa Clinic Business Administration Office
15 Charles Street
Oshawa, ON    L1H 4X5

For more information on privacy issues and the Privacy Act in general, consult the Office of the Privacy Commissioner website or call 1-800-282-1376.

We take our responsibility to safeguard your personal information, as required by the Information and Privacy Commissioner of Ontario, very seriously, and therefore ask that you do not include sensitive personal information (such as your social insurance number, medical status, or details about your finances) in your message.