Release Of Personal Health Information

Medical Forms / Documentation

Patients who submit medical forms for completion will be asked to show photo identification before medical documentation containing personal health information is provided. This is to ensure that patients are provided with their own documentation and their privacy is protected.

If someone else will be picking up your documentation for you, please complete the Consent To Release Form below. Be sure to include the name of the person who will be doing the pickup. If you prefer to write a letter rather than complete the form, please include the following information:

  • Your full name and signature, date of birth, and health card number
  • The type of medical forms requested
  • The name of the person who will be picking up your documents

Please Note:  The person picking up the documentation must provide the C-FHT Business Office with your release form or letter. They will also be asked to provide photo identification matching the name on the release form or letter to obtain your records and to sign your release form or letter to confirm receipt of your documentation.


Your privacy is important to C-FHT and we appreciate your cooperation in helping us make sure that your personal health information is protected.


Consent for Release of Personal Health Information

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